Outing2010
Age
PUBLIC POLICY ISSUES AFFECTING LESBIAN,
GAY, BISEXUAL AND TRANSGENDER ELDERS
BY JAIME M. GRANT
NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE
WITH GERARD KOSKOVICH, M. SOMJEN FRAZER, SUNNY BJERK,
AND LEAD COLLABORATOR, SERVICES & ADVOCACY FOR GLBT ELDERS (SAGE)
Outing2010
Age
PUBLIC POLICY ISSUES AFFECTING LESBIAN,
GAY, BISEXUAL AND TRANSGENDER ELDERS
BY JAIME M. GRANT
NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE
WITH GERARD KOSKOVICH, M. SOMJEN FRAZER, SUNNY BJERK,
AND LEAD COLLABORATOR, SERVICES & ADVOCACY FOR GLBT ELDERS (SAGE)
OUTING AGE 2010
Acknowledgements
T
he Task Force is grateful for the generous support of the Arcus
Foundation, which funded the research, development and publication of
Outing Age 2010. AARP also provided critical support for this research.
This book has been years in the making and has required the careful attention of
many talented researchers and advocates. The Task Force greatly appreciates
the vision and dedication of Amber Hollibaugh who, in her time as Senior
Strategist on Aging at the Task Force, created a national network of advocates
and pioneered many of the perspectives and positions herein.
We want to thank Task Force interns and fellows who made important
contributions to this volume: Ernest Gonzales, Carla Herbitter, Erika Grace
Nelson, Tey Meadow, Patrick Paschall, Angie Gambone, Jesse Zatloff, Meredith
Palmer and also former Senior Policy Analyst Nicholas Ray.
Several experts in LGBT aging helped refine our drafts and hone our perspectives:
Dr. Kimberly Acquaviva, Loree Cook-Daniels, and Dr. Brian DeVries.
At the Task Force, our resident expert on Aging, Dr. Laurie Young, made
essential contributions to the book. Thank you, Laurie, for your patience,
guidance and above all, good humor. Staffers Amy Sagalkin and Darlene Nipper
made extremely helpful editorial comments.
The intrepid Karen Taylor at SAGE in New York kept us on task and gave critical
support, comments and feedback throughout. SAGE has served as a lead
collaborator on this project, and their contribution has been invaluable.
Task Force Vaid fellow Jack Harrison performed the “heavy lifting” on fact and
reference checking and the book’s appendices. He made it possible to get our
final draft across the finish line.
Finally, the shape of this book owes much to its predecessor, Outing Age, and the
sharp thinking of its authors, Sean Cahill, Ken South and Dean Spade. Thanks for
setting such a high bar in research and advocacy for LGBT elders. Your work has
had an enormous impact on the field and the movement as a whole.
1
2
TABLE OF CONTENTS
Table of Contents
Foreword by Rea Carey ............................................................................................................................... 4
Executive Summary and Recommendations ................................................................................ 7
Why This Book?.............................................................................................................................................. 13
Who Are Elders in America in General?......................................................................................... 19
What Do We Know About LGBT Elders?....................................................................................... 24
How Many LGBT Elders Are There? ........................................................................................... 26
Class, Race and Gender in Aging ................................................................................................ 26
The Diversity of LGBT Elder Experience ................................................................................. 28
Living Arrangements: Alone but not Lonely?........................................................................ 30
LGBT Singlehood, Partnership and Kinship.......................................................................... 31
Geography ................................................................................................................................................. 33
Sexuality Over the Lifespan ............................................................................................................. 35
Ageism in LGBT Communities ....................................................................................................... 37
LGBT Elders in Prison ......................................................................................................................... 39
The Way Forward........................................................................................................................................... 42
Discrimination and Access to Services .................................................................................... 43
Cultural Competency..................................................................................................................... 44
Violence................................................................................................................................................. 48
Hate Violence............................................................................................................................. 48
Domestic Violence .................................................................................................................. 50
Elder Abuse................................................................................................................................. 51
Policy Recommendations ................................................................................................................... 53
Financial and Family Security......................................................................................................... 54
Social Security Spousal Benefits............................................................................................ 57
Social Security Survivor Benefits ........................................................................................... 58
Military and Veterans Benefits .................................................................................................. 59
Medicaid Long-Term Care Benefits ...................................................................................... 59
Pensions ............................................................................................................................................... 60
Hospital Visitation and End-of-Life Decision Making.................................................. 61
Policy Recommendations ................................................................................................................... 62
Health ............................................................................................................................................................. 63
Access to Health Care .................................................................................................................. 64
Lack of Insurance .................................................................................................................... 64
Experiences of Fear and Stigma..................................................................................... 69
HIV/AIDS............................................................................................................................................... 73
OUTING AGE 2010
Cancer ................................................................................................................................................. 75
Chronic Disease ............................................................................................................................... 77
Mental Health..................................................................................................................................... 80
Public Health Programs and Outreach ................................................................................ 84
Policy Recommendations ................................................................................................................... 85
Caregiving, Social Isolation, and Housing .............................................................................. 86
Caregiving ........................................................................................................................................... 86
Social Isolation .................................................................................................................................. 89
Housing ................................................................................................................................................. 94
Housing Options for LGBT Older Adults .................................................................... 95
Homecare .................................................................................................................................... 97
Assisted Living .......................................................................................................................... 97
Naturally Occurring Retirement Communities...................................................... 100
LGBT-Targeted Elder Housing ....................................................................................... 101
Policy Recommendations ................................................................................................................ 103
Civic Engagement, Lifelong Learning
and Elders in the Workplace ........................................................................................................ 104
Civic Engagement ........................................................................................................................ 104
Lifelong Learning .......................................................................................................................... 107
Workforce Issues .......................................................................................................................... 108
Policy Recommendations ................................................................................................................ 110
Conclusion ............................................................................................................................................... 111
Key Recommendations ............................................................................................................. 112
Frameworks and Approaches for LGBT Aging Advocates ................................... 114
Key Organizing Opportunities on the Horizon.............................................................. 115
Bibliography ................................................................................................................................................... 117
Appendix A:
How Big Is the LGBT Community? .................................................................. 132
Appendix B:
LGBT Cultural Competency Curricula ............................................................ 139
Appendix C:
A Roadmap to Federal Funding Opportunities .......................................... 141
Appendix D:
LGBT Aging Resources by Region ................................................................... 153
Appendix E:
LGBT and Aging State Non-Discrimination ................................................ 156
Laws and Policies
Task Force Policy Institute Bestsellers ...................................................................................... 158
National Gay and Lesbian Task Force Board .......................................................................... 159
National Gay and Lesbian Task Force Staff ............................................................................. 160
3
4
FOREWORD
Foreword
A
s a 42-year-old who has the great honor of doing this work, I owe a huge
debt to the pre-Stonewall and Baby Boomer generations of lesbian, gay,
bisexual and transgender (LGBT) people who literally put their lives and
livelihoods on the line to ensure that our movement for equality and justice
prevails. Our forbearers created the literature, community centers, newspapers,
grassroots and national organizations, legal protections and sense of possibility
that have formed the backbone of our communities. As these pioneering
generations of LGBT people move into their 70s, 80s, and 90s, I am struck by
the fact that many of them are compelled by circumstance to do what they have
always done in the face of anti-LGBT prejudice and inequality: create change.
I wish it were not so. I wish it was time to relax and say: job well done. But the
hard reality is, many LGBT elders are living in isolation and fear over how they
will sustain themselves as they age, and how they will be treated by providers
of aging services. While much has been accomplished through the passion,
persistence and indomitable energy of LGBT activists on aging over many years,
the aging boom is upon us, and the policies and practices essential to meeting
the needs of LGBT elders are simply not in place.
To address these challenges, the Task Force is proud to re-issue its landmark
book, Outing Age, ten years after its initial publication. What is the state of
aging for LGBT elders? What are our particular strengths and vulnerabilities?
What is the state of progress in federal, state and institutional policies that best
serve LGBT older adults? What can we point to in our organizing, advocacy and
creative adaptations over the past ten years as guideposts to future progress?
Outing Age 2010 charts this important territory.
Black lesbian feminist activist Audre Lorde has said that: “the learning process
is something you can incite, literally incite, like a riot.” If so, we offer this book
to incite the educational “riot” essential to revolutionary thinking and change
regarding the care and treatment of LGBT elders. It is clear that the task before
us requires strategic advocacy and tremendous determination. The Task Force
— along with Services and Advocacy for GLBT Elders (SAGE), statewide LGBT
organizations, local LGBT elder-serving groups and key allies like AARP — is
committed to shining a spotlight on the injustices that continue to create barriers
to aging with autonomy, dignity and affirming community.
OUTING AGE 2010
The scenario of LGBT adults being forced back into the closet for safety
in hostile elder environments is alarming and disgraceful. The Task Force
will ensure that Outing Age 2010 doesn’t sit on a shelf, but informs key
breakthroughs and advancements in advocacy. All of us must work together
to compel the federal government, the states, aging agencies and service
providers, local communities, and public health and housing programs to step
up to the challenge of meeting the vast, unmet needs of LGBT elders.
We must accept nothing less.
Rea Carey
Executive Director
5
6
EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
W
hen the Task Force published Outing Age in 2000, we brought
attention to the reality that LGBT-affirming and LGBT-specific elder
programs were all but non-existent. A decade later, most of the
principal barriers to healthy, empowered aging detailed in the first edition of
Outing Age persist:1
•
Research on LGBT people at the federal and state levels is almost nonexistent, and so the specific needs of LGBT elders remain largely invisible
and unaddressed.
•
Federal, state and local elder housing and care programs, Area Agencies on
Aging, and other providers have no mandate to provide culturally competent
services to LGBT people, while elders report widespread fear, discrimination
and barriers to care.
•
Federal “safety net” programs like Social Security and Medicaid define
family and partnership in ways that disempower and exclude LGBT families,
partners and spouses, creating economic and familial hardships for LGBT
elders.
•
Significant health disparities persist, with no federal commitment to
identifying or addressing them.
•
With no federal prohibition against anti-LGBT workplace discrimination in
place, income inequities across the lifespan persist for LGBT wage-earners.
•
LGBT people who spend their lives working and making productive
contributions to their families and communities remain at high risk in their
elder years for impoverishment, neglect and abuse at the hands of indifferent
aging systems and bigoted individual providers.
There is no doubt that 2009 was a harbinger of change for LGBT elder
advocates, after years of toiling against a tide of indifference, especially at the
federal level. In just one week in October, the Department of Housing and Urban
Development (HUD) issued new regulations prohibiting anti-LGBT discrimination
1
LGBT-Affirming refers to beliefs and actions that validate an individual’s right to identify and live
openly as lesbian, gay, bisexual or transgender.
OUTING AGE 2010
in HUD rental properties and public housing while the federal Administration
on Aging (AOA) announced funding for a national LGBT elder resource center.
HUD also committed to the first federal study on housing discrimination against
LGBT people in U.S. history.2 All of these reforms signal progress in the federal
government’s relationship to LGBT people as a whole, with positive implications
for elders seeking LGBT-affirming housing and care.
Federal and state legal landscapes over the next few years will shift considerably
for LGBT people. As this book goes to print, President Obama has signed the
Matthew Shepard/James Byrd Jr. Hate Crimes Prevention Act, providing landmark
federal protections to LGBT people against hate-motivated violence. Passage
of the Employment Non-Discrimination Act (ENDA), stonewalled for over two
decades in Congress, appears imminent. The Department of Health and Human
Services has confirmed that it will commission a first-of-its-kind Institute Of
Medicine Report on LGBT Health, and is considering the creation of an Office of
LGBT Health. The Census Bureau is piloting research to improve data collection
on same-sex couples. Across the federal government, the question of how best to
pose LGBT questions in federal surveys is an active discussion.
These changes are a result of forty years of unwavering advocacy within the
LGBT movement. And while we must certainly pause for celebration, the
significant work of implementing these and the great many changes to come —
of pressing for accountability — is upon us. While we have spent the past four
decades raising the LGBT question, and arguing for our basic humanity, the next
four will entail shaping and enforcing policies that best serve the great breadth
of needs in our community. Within this transformative context, identifying and
addressing the needs of LGBT elders is paramount.
Accordingly, the National Gay and Lesbian Task Force urgently proposes this set
of comprehensive recommendations to appropriately address the LGBT aging
boom.
2
Also in October 2009: The LA Gay and Lesbian Center, one of the oldest and largest LGBT
organizations in the world, was awarded a grant from the federal government’s Administration
on Aging for its Aging-in-Place initiative; this is the first direct grant by the federal government
to an LGBT organization for aging services. Just two weeks later, Equality California announced
significant state funding for a youth and elder mental health research project, another historic
first.
7
8
EXECUTIVE SUMMARY
KEY POLICY RECOMMENDATIONS
•
The federal government and the states must fund and include questions
on sexual orientation and gender identity in all research surveys so that the
specific strengths and vulnerabilities of LGBT elders can be identified and
addressed.3
•
The federal Administration on Aging should issue guidelines to the states to
include LGBT elders as a “vulnerable senior constituency and identity” and
those with the “greatest social need.”
•
Pass the Employment Non-Discrimination Act (ENDA) to minimize workplace
discrimination over the lifespan so that LGBT people do not face their elder
years at an economic disadvantage. Enforce state and local employment
non-discrimination laws.
•
Enforce existing — and pass additional — state and local laws banning
discrimination on the basis of age, sexual orientation and gender identity and
expression in public accommodations such as senior centers, public housing
and nursing facilities.4
•
Reframe and expand the definition of family to recognize same sex
relationships and LGBT family kinship structures in the designation of federal
benefits such as Social Security, Medicaid and Veterans Benefits.
•
Pass federal and state legislation that ensures access to LGBT-affirming
health care for people of all ages and provides appropriate care for
transgender people.
•
Amend the federal Family and Medical Leave Act to cover LGBT caregivers
and their family and friends, regardless of whether they are related by blood
or marriage.
3
Key federal surveys include the Elder Abuse and Neglect Survey, the National Survey of Family
Growth, the National Health Interview Survey, the National Health and Nutrition Examination
Survey, the American Community Survey, and the decennial Census.
4
HUD’s recent announcement that it will explicitly ban discrimination against LGBT people in
subsidized rentals and public housing provides a key avenue for LGBT advocates to press
publicly funded elder housing programs to address anti-LGBT bias. To access the official press
release announcing the change: www.portal.hud.gov/portal/page/portal/HUD/press/press_
releases_media_advisories/2009/HUDNo.09-206
OUTING AGE 2010
5
•
Amend the Fair Housing Act and other housing laws to include specific
non-discrimination policies that protect LGBT people, and tie the receipt of
federal and state funding to compliance.
•
Call upon the U.S. Department of Housing and Urban Development (HUD)
to enforce its LGBT anti-discrimination regulations and to require grantees in
elder housing to obtain certification as culturally competent to serve LGBT
elders.
•
Press governmental agencies at the federal, state and local levels to
facilitate innovative funding programs for LGBT-targeted and LGBT-affirming
affordable and low-income housing.
•
Vigorously call upon and enforce the Joint Commission’s anti-LGBT
discrimination accreditation rules in assisted living facilities and nursing
homes to catalyze wholesale change in assisted living and nursing care for
LGBT people.
•
Train public and private healthcare providers in cultural competence for
working with LGBT older adults. Tie funding, accreditation and degree
requirements in medical, nursing and social work schools to LGBT cultural
competency certification.5
•
Develop and institute health promotion and healthcare-access policies and
programs specifically designed to bring needed care to older LGBT people
including, but not limited to, those living with HIV/AIDS.
•
Support a National AIDS Strategy that would include the establishment of
prevention, testing and treatment guidelines and programs designed to
specifically address the issue of HIV/AIDS among LGBT people ages 50plus.
•
Reach out to LGBT caregivers to inform them about services they can
receive from the National Family Caregiver Support Program.
•
Fund and develop programs that are specifically designed to address social
isolation among LGBT elders, such as LGBT-specific and LGBT-affirming
friendly visitor programs.
Cultural Competency refers to the ability of care providers to interact sensitively with members
of different cultural groups. Such care generally involves not only an acceptance of and respect
for difference, but also a degree of understanding of community norms, vulnerabilities and
practices.
9
10
EXECUTIVE SUMMARY
FOR LGBT ORGANIZERS AND ADVOCATES,
WE OFFER THESE FRAMEWORKS AND APPROACHES:
Build Holistic, Strategic Approaches to Advocacy: What approaches promise
to address the needs of the broadest population of LGBT elders?
•
Securing universal health care access and culturally competent care would
meet the needs of elders across all income categories and family structures.
•
Developing LGBT-friendly public and affordable housing will meet the needs
of greater numbers of LGBT elders.
•
Prioritizing advocacy for a broader definition of family in federal programs
would address the needs of LGBT elders living in any/many different kinds of
family configurations, including single elders.
•
LGBT advocates would do well to think about peer movement coalitions that
are natural allies in the struggle for LGBT elder care, such as the disability
rights movement, racial and economic justice organizations, and HIV
advocates.
•
Given the limited capacity of the LGBT movement, what are the best
strategies for leveraging our passion and our strengths toward the greatest
good?
Finally, two critical opportunities for organizing and change lie on the horizon for
advocates in LGBT aging:
THE 2011 REAUTHORIZATION OF THE OLDER AMERICANS ACT (OAA)
In its current form, the Older Americans Act remains massively under
funded to meet the needs of all older Americans. Organizing for the 2011
reauthorization should focus intently on the importance of resource allocation
to meet the needs of the nation’s burgeoning aging population.
LGBT elders are also virtually invisible in the Act, which discusses the
importance of addressing the needs of “vulnerable senior constituencies”
but fails to name them. This has left LGBT advocates with an opening to
advocate for explicit language on LGBT people in the regulations for the
current Older Americans Act, something that is just underway as we go
to print with this book, and the Administration on Aging has committed
to funding a National LGBT resource center. Accordingly, a key point of
organizing for the 2011 reauthorization is explicit language that identifies and
defines “vulnerable senior constituencies.” Finally, defining and mandating
OUTING AGE 2010
culturally competent care for LGBT elders (and other vulnerable populations)
could be addressed in this bill, with LGBT advocates forming strategic
coalitions with other underserved communities.
THE 2015 WHITE HOUSE CONFERENCE ON AGING (WHCOA)
Every ten years, aging policy gets a major examination and revision through
the White House Conference on Aging. In 1995 and 2005, LGBT activists
pushed for inclusion in the aging agenda from a marginalized, outsider’s
position — movement pioneers Del Martin, Phyllis Lyon and Amber
Hollibaugh were among the advocates pivotal to these efforts. In 2015, the
LGBT communities, including experts in LGBT aging, must be on the inside
of the planning process for the WHCOA, and in the leadership that drives
the conversation and policy recommendations that flow from the gathering.
“Inclusion” of LGBT issues on a laundry list of concerns will not be enough.
Leadership by recognizable, accountable LGBT elder advocates and
researchers is essential.
The Task Force urges federal, state and local officials charged with the
care of LGBT elders, as well as advocates in LGBT aging, to take up these
recommendations with vigor and without delay.
11
Amirah Watkins-Brown Chicago, Illinois, 61
lesbians, seen as spinsters who
simply had not found the ‘right
man’ yet. And so when I did come
out to my mother, she expressed
fear for my safety and said, ‘I
just don’t want you to get hurt.’”
Amirah recalls that little changed
in Chicago in the wake of the
1969 Stonewall Riots in New York
City. “We still had the same police
harassment, from haters to the
police, and the police were usually
the more aggressive ones.”
A
mirah Watkins-Brown was
born in Jackson, Mississippi
in 1948. Her mother, who was of
German, Indian, and Irish descent,
experienced aggressive racism
for her relationship with Amirah’s
father, an African-American
man. The family soon moved
to Chicago in hopes of raising
Amirah in a more hospitable
environment.
At the age of 4, Amirah recalls
discovering her attraction to other
girls. “I had a little friend who lived
down the street and she would
come over to play and we became
fast friends. One day she declared
that we would play ‘house’ just
like her ‘Mommy and Daddy’ did.
And then she kissed me, and it
was absolutely the most glorious
feeling, and I thought to myself,
Wow, I want to do that again! And
I have been playing house with
women ever since!”
It was far from easy being
LGBT during the 60s and 70s
in Chicago. “It was crazy here.
Women were raped for being
In the 1990s, Amirah began
volunteering at the Howard
Brown Health Clinic in Chicago,
a hospital specializing in LGBT
health care. She became an
advocate for safer-sex practices,
speaking at health fairs in malls,
schools, college campuses, and
diversity expos.
Amirah began to identify a need
for culturally sensitive doctors
and medical services. She notes
that although LGBT people have
a far easier time now than they
did when she was younger, “we
have all of these ‘out’ people
running around, but what’s going
to happen to these people when
they need someone to take care
of them?” Amirah recalls the first
time that she felt homophobic
discrimination by her then-doctor.
“We were talking, very cordially
and friendly, and he started his
exam, checking my neck and
lymph nodes without any gloves
on. And we were chatting really
casually, and he asked me if I was
sexually active, and I said yes,
and then he asked me if there was
any chance I might be pregnant,
and I of course said no, and
then, he asked me if I was using
any protection, and I said, ‘No, I
sleep with women and that’s all
the protection I need.’ And I tell
you, once he found out I was in
a relationship with a woman, he
immediately put on gloves and his
demeanor totally changed after
that.”
Amirah began hearing similar
stories from LGBT friends and
realized the pervasiveness of
discrimination against LGBT
people in the medical field. “These
doctors and nurses and aides
seriously need sensitivity training.
I’ve heard it all: ‘The reason you
have a yeast infection is because
you’re a lesbian;’ or, ‘The reason
you have eczema or acne is
because you’re gay.’ It’s just the
typical bull you hear from nonculturally competent doctors.”
“I believe all of us are created
equally—and I say that whether
you’re polka-dotted, straight,
green, whatever. Who you are,
or whoever you love or whatever
you do, doesn’t need to be
understood by everybody, but it
does need to be respected.”
OUTING AGE 2010
Why This Book?
Mr. Jordan stated that he is a 59-year-old female-to-male transsexual
of mixed race. Being a poor, minimum wage worker, he is dependent on
the public healthcare system. He has been in nursing care facilities and
sees horrible treatment of queers there. He stated that should his life
deteriorate to [that] point, he would rather kill himself than live in such
circumstances.
—Report of the San Francisco Human Rights Commission
(October 2002)
I
n 2000, the Task Force released a groundbreaking report, Outing Age,
which exposed the collision of ageism, sexphobia, and homophobia that
makes dignified, secure aging as a lesbian, gay, bisexual or transgender
person a process fraught with obstacles.6 American society commonly views
older adults as asexual while perceiving LGBT people as universally young
and sexually rebellious. The simultaneous impact of these prejudices renders
6
Ageism refers to prejudicial feelings or actions based on beliefs about the limitations of abilities
due to age, most often directed against elders or youth. Institutional ageism manifests in
poor policies that belittle or demean people based on age, such as elder care policies that
infantilize, desexualize or disempower elders.
Sexphobia means fear of sex; while our culture is rife with images of commercial sexuality,
sexphobia refers to the fear of authentic, empowered expressions of sexuality across the wide
spectrum of possibilities. Institutional sexphobia may be expressed in abstinence-only sex
education programs, or a failure to address sexuality in health care or elder care.
Homophobia refers to feeling or actions based on hatred, aversion or fear of same-sex
attraction and sexual behavior among lesbian, gay or bisexual people. Non-conforming gender
expressions often incite homophobic responses. Institutional homophobia is expressed in
systemic discrimination such as workplace or public policy inequities based on perceived or
actual sexual orientation.
Lesbian and Gay refers to individual people who are romantically and/or sexually attracted to,
and/or partner with people of the same gender; lesbians partner with women and gay men
partner with men.
Bisexual people are romantically and/or sexually attracted to, and/or partner with people of
more than one gender.
Transgender describes people who identify with or express a gender different from the sex
assigned to them at birth.
13
14
WHY THIS BOOK?
LGBT elders at best invisible and at worst expendable.7 The original edition of
Outing Age explored this quandary in detail, revealing a dearth of resources to
support LGBT older adults and making policy recommendations to address the
inequities these elders face.
In the 10 years since its publication, Outing Age has had a tremendous impact
on both the field of aging and the LGBT community. While only a handful of
local and national LGBT groups in the United States addressed aging in 2000,
the ensuing decade saw the building of numerous LGBT elder-specific projects
and organizations. Concurrently, the nation’s vast aging apparatus increasingly
awoke to the reality of LGBT aging and began to respond:
•
The American Society on Aging’s LGBT Aging Issues Network, formally
recognized in 1994, has become a major resource in LGBT aging over the
past 15 years.
•
The 2005 White House Conference on Aging was pushed to address LGBT
issues, as a result of significant preconference organizing by the Task Force
and its allies.
•
AARP created an Office of Diversity and Inclusion that addresses sexual
orientation as one of its concerns. The organization’s “Divided We Fail”
campaign recruited the Task Force and other major LGBT advocacy
organizations as endorsing partners.
While major policy gains for LGBT elders have been limited, a few significant
advances have created new protections and possibilities at the national level
and in two leading states:
•
The Department of Housing and Urban Development has issued LGBT antidiscrimination regulations in publicly funded housing, with explicit language
re-defining “family” so that LGBT families do not face impediments to
qualifying for HUD programs.8
7
The terms elders and older adults refer to people 65 years and older, the current standard age
of retirement in the U.S.
8
HUD has announced its intention to: “clarify that the term ‘family’ as used to describe eligible
beneficiaries of our public housing and Housing Choice Voucher programs include otherwise
eligible lesbian, gay, bi-sexual or transgender (LGBT) individuals and couples. HUD’s public
housing and voucher programs help more than three million families to rent an affordable
home. The Department’s intent to propose new regulations will clarify family status to ensure its
subsidized housing programs are available to all families, regardless of their sexual orientation
or gender identity.” To see the press release, go to: www.portal.hud.gov/portal/page/portal/
HUD/press/press_releases_media_advisories/2009/HUDNo.09-206
OUTING AGE 2010
•
The Administration on Aging has announced funding for the creation of a
national LGBT resource center.
•
Massachusetts and Vermont provide state-based safety nets for LGBT
same-sex couples that cover the costs of the community spouse retaining a
jointly owned home in the event of one partner needing long-term, Medicaidfinanced care.9
•
In 2007, California passed the Older Californians Equality and Protection Act,
which requires Area Agencies on Aging throughout the state to include LGBT
people in their data gathering and planning and in regional and local services
development.10
•
Updated language in the 2006 reauthorization of the federal Older Americans
Act extended the definition of caregiver beyond legally married spouses and
blood relatives, enabling members of LGBT chosen families to qualify for
benefits under the Family Caregivers Support Program for the first time.11
•
The federal Pension Protection Act of 2006 provides a direct rollover option
to nonspousal beneficiaries of pension plans, enabling them to avoid tax
penalties. Any person in an LGBT elder’s chosen family—spouse, unmarried
partner, or other chosen family member may be designated a beneficiary and
receive these benefits.12
•
In 2002—2003, the Joint Commission on the Accreditation of Healthcare
Organizations (now the Joint Commission), the key body that accredits
healthcare facilities nationwide, added respect for sexual orientation to its
patient rights’ requirements for assisted living and skilled nursing facilities.
This provision gives LGBT advocates a formal policy to press when
confronting discrimination in service delivery.13
9
“Community spouse” is a term used to refer to an individual living in the community who has a
partner living in long-term care.
10
Older Californians Equality and Protection Act, (2007). A.B. 2920
11
See The Older Americans Act of 1965. (1965). P.L. 89-73: Title III(A), Sec. 302(3) as amended by
P.L. 109-365, enacted October 17, 2006
12
The Pension Protection Act of 2006. (2006). P.L. 109-280: Sec. 829(a)(II)
13
American Society on Aging. (2003, March). Assisted Living Standards to Recognize Sexual
Orientation. ASA Connection. Retrieved from www.asaging.org/asaconnection/03mar/pplink.
cfm
15
16
WHY THIS BOOK?
These gains are laudable, but in the bigger picture of LGBT aging, they are
limited. The very recent changes at the federal level herald a brighter day for
LGBT elders, yet to be realized. At the state level, the California legislation
provides an outstanding example of appropriate state intervention on behalf of
LGBT elders, but it is an unfunded mandate, with no money included to ensure
cultural competency training. Nor has the law been replicated in other states.
Similarly, the Joint Commission’s policy on nondiscrimination in long-term care
currently exists largely on paper; standard-setting, monitoring, enforcement
and requirements for cultural competence training remain to be put in place.
In general, LGBT elders continue to face tremendous barriers to aging in safe,
affirming environments:
•
Workplace discrimination over the life course leaves LGBT people
economically vulnerable as they approach their later years.
•
The legal disenfranchisement of LGBT chosen families—whether spouses
and partners or extended networks of intimate friends—renders LGBT
support systems fragile and economically disadvantaged.14
•
The presumption that all elders are heterosexual creates unwelcoming
conditions for LGBT people in aging services, healthcare and other
institutional settings.15
•
LGBT-affirming elder housing and culturally competent care is nearly
nonexistent.
•
The assets of LGBT older adults continue to be drained and compromised
by discriminatory policies in Social Security, Medicare, and Medicaid.
•
LGBT older adults who came of age before the gay liberation movement
of the 1970s have lived largely in the context of extremely hostile social,
medical and mental health systems, making self-advocacy within aging
services agencies or institutional settings overwhelmingly difficult for many of
these elders.
14
Legal disenfranchisement refers to the deprivation of legal rights, in this case pertaining to the
LGBT community.
15
Heterosexism, heterocentrism and heteronormative are all words used to signify the
presumption, active in almost all social contexts, that everyone is heterosexual until proven
otherwise. Institutional heterosexism is expressed by policies and practices that reflect that
presumption, often rendering LGBT people and their families invisible.
OUTING AGE 2010
•
Older adults who came of age after the Stonewall Rebellion have had to
blaze a path toward LGBT equality their entire lives, yet face their elder
years with the same daunting task ahead of them—needing to advocate for
respect and equal treatment from the institutions and services essential to
their well-being.16
•
Ageism in LGBT communities adds to the burdens faced by LGBT older
adults, leaving many of our elders isolated or alienated from the larger LGBT
community.
Nearly a decade after the original publication of Outing Age, the Task Force
offers Outing Age 2010 as an update on both the barriers faced by our elders
and the progress made toward creating a safe and dignified old age for all LGBT
people. This new edition was sparked by such questions as the following:
•
What do we know now that we didn’t know in 2000 about the vulnerabilities
and strengths of LGBT elders?
•
How do homophobia and transphobia in the workplace affect our economic
security as we age?
•
What is the impact of the HIV epidemic on LGBT older adults?
•
What is the continuing effect of racism on the ability of LGBT
elders of color to achieve economic security and appropriate housing and
health care?
•
What options exist for LGBT people wishing to remain in their homes and
communities?
•
What success are we having in obtaining funding LGBT-specific services for
older adults?
These are just a few of the critical concerns we address in this report. The
Task Force presents Outing Age 2010 as both a resource for—and a challenge
to—professionals and policymakers charged with meeting elders’ needs. All
LGBT people deserve to age in caring, LGBT-positive, sex-positive, culturally
competent environments that respect their decisions about how open they
wish to be regarding their sexual orientation and gender identity. The system of
services for older adults in the United States must adapt to the reality that this
16
The Stonewall Rebellion is widely regarded as the igniting event of the modern LGBT rights
movement. In June of 1969, gay and transgender patrons of the Greenwich Village Stonewall
Inn bar rioted for three days against police brutality and harassment.
17
18
WHO ARE ELDERS IN AMERICA IN GENERAL?
The courage and
tenacity of LGBT
older adults
have created
a new world of
possibility for
LGBT people of
every generation
to come.
generation of LGBT elders has created with such grace and
determination: the days of the enforced closet are long over.
LGBT elders who find themselves in the nation’s wideranging system of aging-related benefits, institutions and
services must not be shamed or marginalized. The courage
and tenacity of LGBT older adults have created a new
world of possibility for LGBT people of every generation to
come. At the Task Force, we are committed to working to
ensure that the sacrifice and determination of these elders is
rewarded by an increasingly safe, economically secure and
joy-filled old age.
Outing Age 2010 is a fresh demonstration of this
commitment.
OUTING AGE 2010
Who are Elders in America in General?
W
e know a good deal about older Americans, thanks to significant data
gathering by the government agencies like the United States Census
Bureau, the Administration on Aging in the Department of Health and
Human Services, as well as advocacy organizations such as AARP and the
Older Women’s League, and by academic gerontologists.
A RAPIDLY GROWING POPULATION
The population of people ages 65-plus in the United States has grown
dramatically over the past century, largely due to increased life expectancy.
While the U.S. population overall has tripled in this period, the elder population
has increased twelvefold. Today nearly 37.9 million Americans are 65 or older,
representing 12.6% of the population, or one in eight Americans. Most older
Americans are women: more than 21.9 million, versus 16 million men. Fifty-one
percent of elders are 65—74 years of age, 34% are 75—84, and 15% are 85 or
older. A substantial increase will occur between 2010 and 2030, after the first
of the baby boomers turn 65 in 2011. In that period, the number of elders in the
U.S. will nearly double, from 37.9 million to 72.1 million, at which point, one in
five Americans will be 65 or older.17
AN INCREASINGLY DIVERSE POPULATION
Today, people of color make up roughly 20% of the population of elders in the
United States.18 Eight percent are African American, 6.6% Hispanic, 3.2% Asian/
Pacific Islander, and less than 1% Native American.19 Projections indicate that
by 2030, the composition of the older population will be more diverse: 72% will
be non-Hispanic white, 11% Hispanic, 10% Black, and 5% Asian. The older
Hispanic population is projected to grow rapidly, from just over 2 million in 2003
to nearly 8 million in 2030, at which point it will surpass the size of the older
Black population. The older Asian population is projected to grow from nearly 1
million in 2003 to 4 million by 2030.
17
US Department of Health and Human Services, Administration on Aging. (2008). A Profile
of Older Americans: 2008. Retrieved August 29, 2009, from www.aoa.gov/AoARoot/Aging_
Statistics/Profile/index.aspx
18
US Department of Health and Human Services, Administration on Aging. (2008).
19
US Department of Health and Human Services, Administration on Aging. (2008).
19
Shaba Barnes Albuquerque, New Mexico, 73
graduate degrees and stay in their
chosen career most of their life.
They earned good wages and
were thus able to save more for
the future.”
A
lthough she counts
Copenhagen, Casablanca,
London, Paris, Spain, and the
Island of Menorca among her
all-time favorite places in the
world, Shaba Barnes says she will
always be an “East-Coaster” at
heart. Born in 1935 in New York
City, she grew up in an Orthodox
Jewish family of African American
descent, and remembers
searching passionately for her
own sense of spirituality and
purpose while growing up. She
met her partner of 40 years while
living in New York, and together
raised their four children, who
then provided them with 16
grandchildren and 10 greatgrandchildren.
As a young lesbian, Shaba
remembers that while she and
her partner both worked multiple
jobs, they were always struggling.
“I noticed that many of my white
peers often had families with
money. They entered the higher
income bracket because they
were able to complete college
at an earlier age, receive their
At 33, Shaba moved to Los
Angeles and found her calling as
a New Thought Minister in 1980.
She became a regular minister at
a church in L.A., landed a weekly
radio show, and became involved
in Women Prison Ministries. It
was around this time that Shaba
helped lay the groundwork
for what would become one
of the premier lesbian aging
organizations in the country,
OLOC (Old Lesbians Organizing
for Change).
“There’s a lot to be said about
being in the right place at the right
time. It was early 1986 when I
received a phone call from a friend
whom I had met years earlier at
a feminist bookstore, asking me
to help plan a West Coast ‘get
together’ for older lesbians, 60+
over.” The conference became
the focal point for OLOC—to
empower and celebrate older
lesbians, and to fight ageism
within the LGBT community as
well as at large. Ageism has been
a difficult challenge to eliminate.
Even many of the Old Lesbians
enact internalized ageism. They
do not want to be called ‘old.’
They prefer to be called elders,
seniors, older, but never old.
The term that sets us apart, the
very word that empowers us, is
whispered behind our backs by
others, effectively dismissing us
as out-of-touch, irrelevant, or
discounted.”
Nevertheless, Shaba notes
progress in confronting ageism
within the LGBT community in
the last few years. “I particularly
want to point out the changes
that I have witnessed at NGLTF’s
Creating Change conference.
For many years OLOC members
facilitated workshops caucuses,
speaking mostly to ourselves and
our own generation about ageism.
Today, I see day-long institutes
with speakers drawing all cultures
and ages of LGBT participants
who are all working, sharing, and
getting together to discuss issues
surrounding ageism. This year
(2009) was the first time we were
invited to participate in the all-day
intensive institute around aging.”
Shaba notes, however, that there
is still much work to be done.
Eventually, Shaba hopes that the
community will come to recognize
that aging is an issue germane to
people in all stages of their lives,
that aging is something that we
should all hope to experience.
“We need to have dialogue
about how ageism works. Our
community and our society
function like a domino effect:
when OLOC gains a victory, we all
gain that victory. After all, aren’t
we all swimming in this same river
called Life?”
OUTING AGE 2010
PEOPLE ON LIMITED INCOMES
Federal data demonstrates that poverty is a stark reality for millions of older
Americans—and the income thresholds set in federal definitions of poverty are
so low that they clearly underestimate the problem.20 In 2007 the median annual
income of Americans 65-plus was $24,323 for males and $14,021 for females.
About 3.6 million elders (or 9.7%) lived below the poverty level, defined as
$9,944 for an individual age 65 or older. Another 2.4 million (6.4%) are classified
as near-poor, with their income falling between the poverty level and 125% of
that level. Without support from Social Security, the official poverty rate among
elders would rise from 9.7% to nearly 47%.21
A number of interrelated factors increase the likelihood of poverty among elders
in the United States, as the following data from the federal Administration on
Aging indicates.22
•
Older women experience a higher poverty rate (12%) than older men (6.6%).
•
Elders living alone or with nonrelatives are more likely to be poor (17.8%)
than are those living with their families (5.6%).
•
One of every 14 whites ages 65-plus are poor (7.4%), compared to nearly
one in four Black elders (23.2%); about one in six Hispanic elders (17.1%);
and more than one in 10 Asian elders (11.3%).
•
The highest rates of poverty among elders were experienced by Hispanic
women who live alone (39.5%) and African American women who live alone
(39%).
•
Older people living in rural and urban areas, as well as in the South and
Southwest, are more likely to live in poverty than are those in other parts of
the country.
20
In 2008, with the exception of Alaska and Hawaii, the federal poverty level for a household of
one was $10,830 and for a household of two was $14,570. See US Department of Health and
Human Services, Administration on Aging. (2009). HHS Poverty Guidelines. Retrieved August
29, 2009, from www.aspe.hhs.gov/poverty/09poverty.shtml
21
The statistics on income and poverty levels for elders are drawn from US Department of Health
and Human Services, Administration on Aging. (2008).
22
US Department of Health and Human Services, Administration on Aging. (2008).
21
22
WHO ARE ELDERS IN AMERICA IN GENERAL?
•
The District of Columbia, Kentucky, Louisiana, Mississippi, New Mexico and
North Dakota have the highest rates of elder poverty (ranging from 13% to
14.6%).
Disproportionate poverty among Black and Latino elders is partly an outcome of
their lower levels of educational attainment compared to non-Hispanic whites.
This disparity is a result of institutionalized racism as reflected in segregated and
lower-quality schools and in the disproportionate impact of poverty on Black
and Latino elders’ families of origin, which forced many to leave school early to
join the workforce. While 81% of older whites graduated from high school, only
57% of Black and 42% of Hispanic elders did. And while 20% of elders overall
graduated from college, only 11% of Black elders and 9% of Hispanic elders
did. Lower levels of educational attainment, lower lifetime earnings, and fewer
years in the workforce—also due in large part to sex and race discrimination—
mean that women and people of color have lower incomes in retirement, as
pensions and Social Security pay more to those with a history of higher earnings
and more years of paid work.23
LIVING ARRANGEMENTS
About 30% of elders in the United States lived alone in 2007. Only 19% of older
men lived alone, versus 38% of older women; this is in large part due to the
longer life expectancy of women.24 About 5% of women and 4% of men ages
65-plus have never married.25 A relatively small percentage of the population
ages 65-plus—4.4% (or 1.57 million)—lived in nursing homes in 2007.26 The
percentage increases dramatically with age, ranging from 1.1% for those
65—74 years old to 4.7% for those 75—84 and 18.2% for those ages 85-plus.27
Additionally, approximately 5% of older adults live in self-described senior
housing of various types, many of which have supportive services available to
their residents.28
23
See sections, “Geographical Distribution” and “Poverty,” in US Department of Health and
Human Services, Administration on Aging. (2008).
24
US Department of Health and Human Services, Administration on Aging. (2008).
25
US Department of Health and Human Services, Administration on Aging. (2008).
26
See section, “Living Arrangements,” in US Department of Health and Human Services,
Administration on Aging. (2008).
27
US Department of Health and Human Services, Administration on Aging. (2008).
28
US Department of Health and Human Services, Administration on Aging. (2008).
OUTING AGE 2010
GEOGRAPHIC DISTRIBUTION
The population of older adults in the United States is concentrated in a number
of states, with some clear clustering around race and culture. In 2000, almost
three-quarters of all older Hispanics lived in four states: California, Florida,
Texas, and New York. Nearly two-thirds of older Asians lived in the West.29
Florida—traditionally a popular retirement destination—has the highest
percentage of elders, with 18.5% of its population ages 65 or older. Other states
with significant elder populations are Pennsylvania and Rhode Island at 15.8%
each, and Iowa at 15%.30
29
He, W., Sengupta, M., Velkoff, V., & DeBarros, K. (2005). 65+ in the United States: 2005. US
Census Bureau. Retrieved August 29, 2009, from www.census.gov/prod/2006pubs/p23-209.pdf
30
US Department of Health and Human Services, Administration on Aging. (2008).
23
24
WHAT DO WE KNOW ABOUT LGBT ELDERS?
What Do We Know
About LGBT Elders?
Despite extensive general data on elders and decades of advocacy by LGBT
activists, only a handful of state and federal demographic and health surveys
collect data on LGBT elders.31 As a consequence, when seeking data on the
total number of LGBT older adults, their geographical distribution, their health
and economic status, their need for supportive services and other crucial
concerns, we often are forced to draw on qualitative rather than quantitative
data—or must extrapolate from limited samples or research on related groups.
These approaches help us identify many of the basic issues of LGBT aging—
and help us raise important questions which demonstrate that comprehensive,
fully funded research about LGBT elders is needed at the national and state
levels. One thing is abundantly clear from the limited data at hand: LGBT elders
remain an underserved and highly vulnerable population.
Much of what we currently know about LGBT elders in the United States comes
from the pioneering social science research conducted by a handful of scholars
since the mid-1970s. Most of these studies rely on cohorts of white gay men;
a smaller number focus on lesbians. Very few include transgender or bisexual
elders or examine the findings to discern issues of particular concern to these
elders.32 And most of the studies involve small sample sizes that do not reflect
the racial and economic diversity of the LGBT community.33
Gilbert Herdt and his colleagues reported in 1997 that, “in the case of older
bisexuals, lesbians and gays, the combination of poor research literature,
clinical samples, and dated historical narratives from prior generations has
had the effect of making this population appear more homogeneous than it is,
31
The National Survey of Family and Social Growth, statewide Youth Risk Behavior Surveys in
a handful of states including Massachusetts and New York, the California Health Interview
Survey, The Harvard Nurses survey and a few state tobacco surveys ask questions about
sexual orientation. This patchwork of largely health surveys gives us a fragmented view of the
health and social issues in LGBT people lives.
32
One study that has been published is Witten, T. M. (2002). “Geriatric Care and Management
Issues for the Transgender and Intersex Population”. Geriatric Care and Management Journal,
12(3)
OUTING AGE 2010
undercutting diversity in life-course experience.”34 In the more than a decade
that has passed since that assessment, the research literature on LGBT aging
has been grown in both depth and sophistication, but large-scale and long-term
quantitative research on LGBT aging largely remains to be done; in addition,
many crucial areas of concern have received little or no attention, even in
qualitative studies.
A groundbreaking 1999 report by the Committee on Lesbian Health Research
Priorities of the Institute of Medicine underscores the limited research on
lesbians in the United States, noting that “most existing studies portray crosssections of experience at one point in time and so cannot address compelling
questions of behavior, identity, or attraction across time. Prospective,
longitudinal studies are essential for understanding the vulnerability, resilience,
and well-being of lesbians across their life span.”35 Such studies would have
particular significance for illuminating the strengths and vulnerabilities of
lesbians in midlife and old age which reflect not only their current circumstances
but also the legacy of their earlier life experiences.
Future research must do better at gathering information on all LGBT elders,
including people-of-color, low-income, and immigrant populations. The following
sections synthesize what we know about LGBT older adults or can reasonably
argue regarding LGBT elders on the basis of research on LGBT people in
general.
33
“Almost without exception,” as one social science literature review notes, studies of older gay
men have disproportionately focused on “white, middle class, well-educated, urban-dwelling
men who participate in the gay community through friendship networks, gay bars, support
organizations, etc.” See Wahler, J., & Gabbay, S. G. (1997). “Gay Male Aging: A Review of
the Literature”. Journal of Gay and Lesbian Social Services 6(3), p.5. Another reviewer notes
the pressing need for research which examines “the significance of ethnicity, poverty, and
heterosexism among aging gay men, lesbians, and bisexuals.” See Boxer, A. (1997). “Gay,
Lesbian, and Bisexual Aging into the Twenty-First Century: An Overview and Introduction.”
Journal of Gay, Lesbian and Bisexual Identity 2(3-4), p.191.
34
Herdt, G., Beeler, J., & Rawls, T. (1997). “Life-Course Diversity among Older Lesbians and Gay
Men: A Study in Chicago.” International Journal of Sexuality and Gender Studies 2(3-4).
35
Solarz, A. (ed.) (2008). “Lesbian Health: Current Assessments and Directions for the Future.”
Washington, DC: National Academies Press. Retrieved from www.nap.edu/catalog/6109.html.
25
26
WHAT DO WE KNOW ABOUT LGBT ELDERS?
HOW MANY LGBT ELDERS ARE THERE?
We are able to report at best a qualified estimate of the number or percentage of
lesbian, gay, bisexual and transgender elders in the U.S. population for the same
reason we cannot give an exact number of the total LGBT population of all ages:
In addition to definitional challenges presented by the categories themselves,
few national surveys ask about sexual orientation and fewer still about gender
identity.
In this report, we draw on findings from a 2009 gathering of 34 leading LGBT
researchers who reviewed the limited existing data and literature to establish a
demographic estimate of the LGBT community in the United States as ranging
between 5% and 10% of the population at large. See appendix A for this
discussion, which points to the need for the U.S. Census Bureau and other
federal agencies to gather data on the LGBT population. Taking the statistic of
LGBT people as constituting 5% to 10% of the population and extrapolating
from federal statistics for the number of older adults in the general population,
we estimate that between now and the height of the aging boom, there will be
approximately nearly 2 million to as many as 7 million LGBT elders in the United
States.
CLASS, RACE AND GENDER IN AGING
The paucity of national data means that we know little about the racial and class
diversity in the LGBT community in general and among LGBT elders in specific.
Nonetheless, Lora Connolly, chief deputy director of the California Department
of Aging, has said that there is no reason to believe that the LGBT community is
any less racially diverse than the overall population in the United States.36
Recent studies show that lifelong experiences of social and economic
marginalization place lesbian, gay, bisexual and transgender elders at higher risk
for isolation, poverty and homelessness than their heterosexual peers.37 Given
this fact, LGBT elders are undoubtedly among those with the greatest economic
and social need. Income data for LGBT older adults drawn from scattered local
surveys reinforces this observation:
36
California Department of Aging. (2009). California State Plan on Aging 2005-2009. Retrieved
August 29, 2009, from www.aging.ca.gov/whatsnew/california_state_plan_cda_2005-2009.pdf
37
See, for instance, Albelda, Randy, et al. (2009) Poverty in the Lesbian, Gay, and Bisexual
Community. Los Angeles: The Williams Institute. Available at www.law.ucla.edu/
williamsinstitute/pdf/LGBPovertyReport.pdf.
OUTING AGE 2010
•
Services and Advocacy for GLBT Elders (SAGE), which serves New York
City, reports that approximately 35% of its clients are Medicaid eligible, with
annual pretax incomes below $10,000; an additional 35% subsist on annual
pretax incomes of $20,000 or less.38
•
The Chicago Task Force on LGBT Aging reports that 8.8% of LGBT older
adults in Chicago have an annual income under $10,000, which would put
them below or near the poverty line.39
•
The San Diego LGBT Needs Assessment identified 14% of LGBT people
over 65 reporting incomes of $10,000 or less and 10% reporting incomes
under $20,000. None of the respondents reported incomes over $100,000.40
A recent study from The Williams Institute drawing on census data on samesex couples and on figures from two other federal surveys that ask about LGBT
identity or sexual behavior similarly describes the economic challenges faced by
LGBT elders.41 Comparing couples which include members ages 65 and older,
the study found poverty rates of 4.6% for opposite-sex married couples, 4.9%
for male same-sex couples and 9.1% for female same-sex couples. The study
also found that the following factors are associated with higher rates of poverty:
being Black; living in nonurban areas; living in the East, West, or North Central
regions of the country; having only a high school diploma; being out of the labor
force; and having children. These intertwined factors reflect multiple economic
vulnerabilities for many LGBT elders, coupled or not.
The Transgender Law Center notes that transgender Californians are highly
educated yet twice as likely to live below the poverty line of $10,400 compared
to the general population.42 The Task Force’s forthcoming national study on
discrimination against transgender people found an unemployment rate double
38
Thurston, C. Services and Advocacy for GLBT Elders (SAGE). Journal of Long Term Home
Health Care (forthcoming Fall 2009).
39
Beauchamp, Dennis, Skinner, Jim, Wiggins, & Perry. (2003). LGBT Persons in Chicago: Growing
Older. A Survey of Needs and Perceptions. Chicago Task Force on LGBT Aging.
40
Cook-Daniels, L. (2004). LGBT Seniors-Proud Pioneers: The San Diego County LGBT Senior
Healthcare Needs Assessment. Retrieved September 21, 2009, from www.sage-sd.com/
SeniorNeedsAssessment.
41
Albelda, R., et al. (2009). Poverty in the Lesbian, Gay and Bisexual Community. Los Angeles:
The Williams Institute. Retrieved August, 29, 2009, from www.law.ucla.edu/williamsinstitute/
pdf/LGBPovertyReport.pdf.
42
Transgender Law Center. (2009). The State of Transgender California Report. Retrieved October
14, 2009, from www.transgenderlawcenter.org/pdf/StateTransCA_report_2009Print.pdf.
27
28
WHAT DO WE KNOW ABOUT LGBT ELDERS?
that of the national unemployment rate among its 6,500 respondents. Fourteen
percent of respondents 65 years and older reported incomes below $10,000 and
51% reported an adverse job action.43
Some studies suggest that gay men and lesbian women age differently. There
is some indication that gay men experience what is referred to as “accelerated
aging,” seeing themselves as old as early as their 30s due to the premium
ascribed to youth and beauty in gay male culture; first advanced in popular
literature in the 1960s, this analysis has remained a subject of debate among
researchers.44 Conversely, older lesbians, many of whom came of age during
a period of the women’s movement that rejected traditional notions of beauty
and ageism, report a sense of freedom in their elder years, despite generally
having more economic challenges than their male counterparts.45 Gender
nonconforming and transgender people, by contrast, reach old age in a social
context of rigid gender categories that have largely excluded and demeaned
them.46
THE DIVERSITY OF LGBT ELDER EXPERIENCE
A common mistake that well-intentioned providers make in serving LGBT
elders is to see the community as monolithic—and thus to assume that events
meaningful to relatively gender-conforming, white, middle-class members of this
population may apply to all LGBT older adults. In fact, LGBT communities are as
diverse as their heterosexual counterparts, and our elders’ strategies in surviving
the myriad challenges they have faced in the different contexts in which they
have lived are greatly varied. Anti-LGBT stigma and discrimination is a shared
43
Grant, J., et al. (Forthcoming). Report on National Transgender Discrimination Survey. National
Gay and Lesbian Task Force Policy Institute & National Center for Transgender Equality.
44
For an overview, see Bennett, K. C. & Thompson, N.L. (1991). “Accelerated Aging and Male
Homosexuality: Australian Evidence in a Continuing Debate.” Gay Midlife and Maturity. Lee, J.
A., ed. New York, NY: Haworth Press, pp.65—75.
45
Two classic texts that summarize feminist and lesbian critiques of ageism are the following.
Copper, B. (1987). Ageism in the Lesbian Community. Freedom, CA: Crossing Press;
Macdonald, B., & Rich, C. (1983). Look Me in the Eye: Old Women, Aging and Ageism. San
Francisco: Spinsters Ink.
46
Gender nonconforming people express their gender differently from dominant cultural norms.
Some gender nonconforming people reject the categories “male” and “female” entirely; others
consider themselves a blend of both genders. In lesbian and gay communities, butch lesbians
and feminine gay men have long been targets of abuse for their gender non-conformity. In
recent years, a number of new terms like “genderqueer,” “gender bending” and “gender
blending” emerged as a fluid range of gender identities and expressions have taken hold.
OUTING AGE 2010
challenge that may or may not connect LGBT elders across
the many different identities and communities in which they
are situated.
The current generation of LGBT elders of various genders,
races and economic strata ground their later years on
differing defining moments and sociopolitical contexts. For
many gay men, for example, the post-Stonewall era of gay
liberation is formative, whereas for many white lesbian and
bisexual women, feminism and the women’s movement loom
largest. For African American, Latino and Asian LGBT elders,
the civil rights and labor struggles of the 1960s, as well as
experiences in their church communities, may provide their
grounding for old age. For LGBT immigrants, the trauma
of having survived armed conflict, government repression
and flight from their homelands often is a defining factor in
how they experience their elder years. Among transpeople,
the Stonewall rebellion in 1969 in New York City and the
recently recovered history of the Compton’s Cafeteria riot
in 1966 in San Francisco have strong symbolic resonance
as sites of resistance; at the same time, the greatest growth
in transgender visibility and activism has occurred only
in the past 10 to 15 years, making it very likely that many
transgender elders have spent the bulk of their lives in
isolation, navigating extremely hostile social and workplace
environments.47
Anti-LGBT
stigma and
discrimination
is a shared
challenge that
may or may not
connect LGBT
elders across the
many different
identities and
communities in
which they are
situated.
Researchers in the field of aging often note that people age
as they have lived. LGBT elder resilience will vary greatly
relative to the challenges these older adults have faced
and depending on the resources to which they have had
access across the lifespan and across cultures. Black lesbian
feminist Pat Parker gave this legendary caveat to white allies
in the 1980s about addressing the totality of her experience:
“First thing you do, is to forget that i’m Black/ Second,
47
29
The first documented public protest by transgender people was a peaceful sit-in of Dewey’s
Lunch Counter in Philadelphia in 1965 to protest its refusal to serve transgender patrons;
LGBT people picketed the restaurant collectively. In San Francisco’s Tenderloin District in
1966, transgender patrons of Gene Compton’s Cafeteria spontaneously protested against
police harassment there, and were arrested. See the Movement Advancement Project. (2009).
Advancing Transgender Equality, p.8.
30
WHAT DO WE KNOW ABOUT LGBT ELDERS?
you must never forget that i’m Black.”48 Professionals in aging would do well to
extrapolate from and apply Parker’s standard to their work with a diverse range
of LGBT clients.
LIVING ARRANGEMENTS: ALONE BUT NOT LONELY?
Limited existing research provides some evidence that lesbian and gay elders
are more likely to live alone than are heterosexual older adults. Populationbased data collected by the New York City Department of Health in 2005-2007
suggests that among adults over 50, gay and bisexual men are twice as likely to
live alone as are heterosexual men, while lesbian and bisexual women are about
one third more likely to live alone than are heterosexual women.49 Another study
found that 75% of gay and lesbian elders in Los Angeles lived alone.50 This high
percentage was confirmed in a 2006 study of LGBT older adults living with HIV/
AIDS — which reports that almost 70% of its participants live alone.51
Such statistics may suggest that LGBT older adults in general are vulnerable to
certain physical and mental health challenges for which elders who live alone
are at greater risk; these include falls, malnutrition, depression, and substance
abuse.52 At the same time, LGBT elders’ life experience may in some ways
provide them greater personal resources for coping with living alone. A 2006
study found, for instance, that almost 40% of LGBT baby boomers believe
that being lesbian, gay, bisexual or transgender has helped them prepare
for aging by endowing them with positive character traits, greater resilience,
48
Parker, P. (1999). Movement in Black. Ann Arbor, MI: Firebrand Books, p.68.
49
Prevalence of Living with No Other Adults/with Children among Adults age 50+ in New York
City by Sexual Identity. NYC Community Health Survey, 2005 through 2007. All estimates
are weighted to the NYC population, Census 2000 and age-adjusted to the US Standard
Population 2000. Community Health Survey, Bureau of Epidemiology Services, New York City
Department of Health and Mental Hygiene, July 2008.
50
Rosenfeld, Dana. “Identity Work Among Lesbian and Gay Elderly.” Journal of Aging Studies.
Volume 13,Issue 2, Summer 1999, Pages 121-144. Also, Footnotes 52, the title “Depression,
Social Isolation and the Elderly,”
51
Karpiak, S., Shippy, R., & Cantor, M. (2006). Research on Older Adults with HIV. New York:
AIDS Community Research Initiative of America, p.1.
52
Walker, J., & Herbitter, C. (2005). Aging in the Shadows: Social Isolation among Seniors in
New York City. United Neighborhood Houses: New York. Retrieved September 21, 2009, from
www.unhny.org/advocacy/pdf/Aging%20in%20the%20Shadows.pdf, pp.5-8. And Sederer, L.I.
(2006), “Depression, Social Isolation and the Urban Elderly,” from the Conference on Geriatric
Mental Health, New York.
OUTING AGE 2010
or better support networks than their non-LGBT counterparts. A 2007 study
likewise suggests that older LGBT people’s experiences of forming identity and
community may help them develop particular strengths—including resilience
and adaptability—which serve them as they age.53
LGBT SINGLEHOOD, PARTNERSHIP AND KINSHIP
A significant amount of social science research finds a greater sense of wellbeing among heterosexual elders who are married or in partnered relationships
than among single elders.54 By contrast, no equivalent studies have been
published regarding LGBT elders. Even basic research on the prevalence of
LGBT couples is limited; a number of surveys from the late 1970s to the late
1990s document a range of 40% to 60% of gay men and 45% to 80% of
lesbians in committed relationships at any given time—but the studies do not
include bisexual and transgender individuals and do not break out the data by
age cohort. 55
Many researchers and advocates question whether focusing on coupled status
is the optimal approach to evaluating the role of relationships in sustaining the
well-being of LGBT older adults. The LGBT community has a rich history of
creating kinship structures that expand on the heterosexual model of a married
couple and their biological offspring. Chosen families—single-generation
cohorts of intimate friends and loved ones—have long provided LGBT people
a foundation for surviving intense societal neglect, stigmatization and abuse,
thus supporting health and self-actualization across the lifespan. What may
be the only published study on life satisfaction and psychological adjustment
in single gay men in midlife and older underscores this point: “Social support
from friends and family predicted higher levels of subjective well-being” in the
respondents.”56
53
Grossman, H., Anthony, D., Dragowski, E. (2007). “Caregiving and Care Receiving Among Older
Lesbian, Gay, and Bisexual Adults.” Journal of Lesbian and Gay Social Services 18(3-4).
54
Manzoli, L., et al. (January 2007). “Marital status and mortality in the elderly: A systematic
review and meta-analysis.” Social Science & Medicine 64(1), pp. 77-94.
55
See Partners Task Force for Gay & Lesbian Couples. (2005). Couples in the Hood. Retrieved
from www.buddybuddy.com/surv-rel.html. Also, Peplau, A. (1993). “Lesbian and Gay
Relationships.” Psychological Perspectives on Lesbian and Gay Male Experiences. Garnets, L.,
& Kimmel, D. (eds). New York, NY: Columbia University Press.
56
Hostetler, A. (2005). “Single Older Gay Men: Are They Going It Alone?” OutWorld 11(4), pp.4,7.
The study drew on a convenience sample of 94 self-described single gay men ages 35-plus
from a Midwestern metropolitan area. See also Kooden, H., & Flowers, C. (2000). Golden Men:
The Power of Gay Men at Midlife. New York: Harper Paperbacks.
31
32
WHAT DO WE KNOW ABOUT LGBT ELDERS?
In addition to single-generation chosen family structures, evidence suggests
that some LGBT communities have created cross-generational chosen families,
despite the impediments to intergenerational kinship created by the stereotype
of LGBT older adults as sexual predators. Jenny Livingston’s 1990 film, Paris
is Burning, for example, celebrates a rich intergenerational support system in
the African American LGBT community in New York City. In the social circles
surrounding the drag-ball culture, Black gay and transgender youth who have
been rejected by their families of origin find housing, mentorship, emotional
and financial support by joining solidly structured chosen families referred to as
“houses,” which are headed by Black gay and transgender elders.
Similarly, individuals involved in BDSM and leather communities within the
LGBT community have established practices of mentorship and support for
young people exploring these erotic practices which is not based on sexual
partnership; rather, the mentoring relationship supports safe expression of this
very marginalized sexuality within a hostile larger culture. 57 African American
BDSM activist Graylin Thornton, recipient of the Task Force’s 2009 Leather
Leadership Award, reports that older gay men in the leather scene took him
“under their wing” when he was only 18 and made a serious commitment to his
personal growth and well-being over the course of 20 years.58
Studies show that maintaining extended social networks and lifelong, intimate
friendships can have a positive impact on aging.59 Single-generation and
intergenerational chosen families of the sorts described here may therefore
provide distinctive benefits to LGBT older adults. Beyond purely personal
support, chosen families also may provide a foundation for much-needed
advocacy for LGBT elders. Certainly, the LGBT boomer generation’s experience
57
BDSM (an acronym that encompasses Bondage and Discipline, Domination and Submission,
and Sadism and Masochism) and leather community members engage in sexual practices
that have long been marginalized as “deviant” in both mainstream and LGBT communities.
Providing a foundation for safe, healthy, fully-realized lives within a context of stigmatization
has been a major goal of BDSM and leather queer activists. Moreover, leather community
activists have long pioneered safer-sex practices in LGBT communities and fundraising
campaigns to confront the AIDS epidemic. For more information on BDSM in LGBT
communities, see Baldwin, G. (1993). Ties that Bind, The SM/Leather/Fetish Erotic Style:
Issues, Commentaries and Advice. Los Angeles: Daedalus Publishing; Califia, P., & Sweeney, R.
(2000). The Second Coming: A Leatherdyke Reader. New York: Alyson Books; and Thompson,
M. (2001). Leatherfolk, 10th Edition. New York: Alyson Books.
58
Thornton, G. (2009, February). Acceptance remarks. The National Conference for LGBT
Equality: Creating Change, Denver, CO.
59
Parker-Pope, T. (2009, April 21). “What are friends for? A longer life.” The New York Times.
OUTING AGE 2010
of mobilizing support networks to care for their brothers and sisters living with
HIV and cancer has nurtured both skills and determination which can be applied
to aging in a system ill prepared to support LGBT elders.
What appears in social science literature as single life among LGBT people may
therefore mask multigenerational networks of intimate support, deep friendship,
and alternative parenting which over the lifespan create an emotional and social
safety net equivalent to that of conventional family configurations. We cannot
fully understand how chosen family operates in the lives of LGBT elders until
significant research is commissioned—including studies that break away from
privileging traditional notions of partnership and family.
GEOGRAPHY
No national research synthesizes the geographical distribution of LGBT elders,
yet we can surmise from a literature review that this population is geographically
varied and can be found throughout the United States. Data from the 2000 U.S.
Census, which permitted respondents to indicate that they were members of
same-sex couples, provide a proxy for demonstrating the presence of samesex older adults across the country. The states with the highest numbers of
same-sex elder couples, according to this data, also are those with the highest
population of heterosexual elder couples: California, Florida, and New York.60
Ninety-seven percent of U.S. counties have at least one elder in a same-sex
partnership. 61 Nearly three in five U.S. counties (1,847) have more same-sex
partnered elders per capita than the national average of one in a thousand
people.62
Many same-sex couples live outside major metropolitan areas. Such families
not only may currently include elder members, but also will themselves age over
time; their geographic distribution is thus crucial to understanding current and
future needs for services for LGBT older adults across the United States. The
2000 Census shows 88,606 gay and lesbian families (15% of all such families)
60
U.S. Census Bureau. (2003). Census 2000 Special Reports: Married-Couple and UnmarriedPartner Households 2000. Retrieved from www.census.gov/prod/2003pubs/censr-5.pdf See,
Table 2: Married-Couple and Unmarried-Partner Households for the United States, Regions,
States, and for Puerto Rico: 2000.
61
Urban Institute. (2003). Gay and Lesbian Families in the Census: Gay and Lesbian Elders.
Retrieved on May 19, 2006, from www.urban.org/uploadpdf/900627_checkpoints_elders.pdf.
62
Urban Institute. (2003).
33
34
WHAT DO WE KNOW ABOUT LGBT ELDERS?
living outside metropolitan statistical areas in rural settings.63 This data explodes
the myth that LGBT people live exclusively in urban areas.
Research on LGBT people living in rural environments is very limited. Walter
T. Boulden performed a literature review on gay men and lesbians in rural
environments and found fewer than 20 articles and books.64 Boulden’s
qualitative study of Wyoming residents reported that participants were happy
living in the state despite a “don’t ask, don’t tell” environment in terms of their
survival. Boulden’s subjects described being constantly on guard while trying
to be a good neighbor and worker, maintaining close ties to biological family
members, and interacting with a small core group of friends in the informal,
largely underground LGBT community.
Sandra S. Butler and Barbara Hope’s research on 21 rural lesbian elders in late
middle-age and older revealed concerns regarding healthcare access due to
both poverty and rural geography, as well as some fears related to potential
homophobia should they need long-term care; the study also documented a
general sense of well-being derived from experiences of community and the
natural environment and from the sensitive healthcare professionals they found
in rural practices and hospitals.65 And a study of 15 lesbian elders in Vermont
by Susan A. Comerford and colleagues emphasized the women’s self-reliance
mediated by interdependence.66
The 2000 Census also provided some mapping of same-sex couples across
race. For example, while white same-sex couples reported living in urban and
suburban LGBT enclaves at a high rate, populating what many LGBT people
refer to as “gayborhoods,” Black and Latino same-sex couples reported settling
into communities that were highly concentrated along lines of racial identity.67
This phenomenon suggests that aging in place—the term for aging in the home
63
2003. “Census 2000 Special Reports: Married-Couple and Unmarried-Partner Households
2000.” U.S. Census Bureau. www.census.gov/prod/2003pubs/censr-5.pdf See, Table 2:
Married-Couple and Unmarried-Partner Households for the United States, Regions, States, and
for Puerto Rico: 2000.
64
Boulden, T. (2001). “Gay Men and Living in a Rural Environment.” Journal of Gay and Lesbian
Social Services 12(3-4).
65
Butler, S., & Hope, B. (1999). “Health and Well-Being for Late Middle-Aged and Old Lesbians in
a Rural Area.” Journal of Gay and Lesbian Social Services 9(4), p.27—46.
66
Comerford, S., & Henson-Stroud, M. et al. (2004). “Crone Songs: Voices of Lesbian Elders on
Aging in a Rural Environment.” Affilia 19(4), p.418—436.
OUTING AGE 2010
and community in which one has lived and worked across
the lifespan—will involve widely differing locales and
institutions for LGBT people of varying cultures and races.
SEXUALITY OVER THE LIFESPAN
For the past 20 years, bisexual, feminist, leather and other
LGBT activists have led the charge to open up discussion
about the vibrant diversity of sexual practices and identities
that make up LGBT communities. Anyone who has spent
time in these communities understands that the forging
and claiming of queer identity within a legally and socially
hostile context is often monumental work, and that a
negative outcome of this struggle has been an at-times rigid
enforcement of communal codes of sexual behavior and
identity.
This cultural phenomenon raises important questions for
the sexual identity and expression of LGBT older adults. Is
a self-identified lesbian who begins having sex with men
in her 50s “still” a lesbian? Is a man with a deceased wife
who experiences attraction to men in his 60s welcome in
a community of gay elders? Can elder transwomen who
identify as lesbian move easily into cultural and social spaces
reserved primarily or entirely for older women? Can a single
bisexual elder find safe places to be out in either straightidentified or queer-friendly social contexts?
The largely
unspoken but
widely held
assumption
that elders are
sexually inactive,
heterosexual, and
monogamously
coupled or
widowed does a
disservice to all
older adults.
In her 2002 testimony before the San Francisco Human
Rights Commission, Joyce Pierson from the National Center
for Lesbian Rights described a client “who was widowed
for 30 years, fell in love with a woman at 79, and became
a member in a support group” for LGBT elders. For elders
like this woman, who have lived the majority of their lives
67
35
Gates, G., Lau, H., & Sears, B. (2006, February) Race and Ethnicity of Same-Sex Couples in
California: Data from Census 2000. Census Snapshots. The Williams Institute. Retrieved from
repositories.cdlib.org/uclalaw/Williams/census/ca_race_2000. See also Dang, A. & Frazer, M.
S. (2005). Black Same-Sex Households in the United States, A Report from the 2000 Census,
Second Edition: December 2005. Washington, DC: National Gay and Lesbian Task Force Policy
Institute. Retrieved August 18, 2009, from www.thetaskforce/downloads/reports/reports/2000B
lackSameSexHouseholds.pdf.
36
WHAT DO WE KNOW ABOUT LGBT ELDERS?
within a largely heterosexual, gender-conforming world, experiencing same-sex
desire in midlife or old age can be a daunting, even frightening reality, especially
within the context of aging-related facilities and services that may not only be
unwelcoming to LGBT sexuality, but that may treat all older adults as essentially
asexual.
Alternatively, for LGBT elders who have lived queer-identified lives and find
themselves creating mixed-sex partnerships and attachments in midlife or old
age, the possibility of losing LGBT chosen family or community as a result can
be devastating. The impact of biphobia—a fear and hatred of people whose
sexuality moves fluidly among attractions to people of more than one gender—
has never been examined among elders, despite our understanding that for
some LGBT people, attractions and attachments move along a continuum of
possibilities as they age.
The largely unspoken but widely held assumption that elders are sexually
inactive, heterosexual, and monogamously coupled or widowed does a
disservice to all older adults—but it places LGBT elders at perhaps the greatest
risk for neglect, discrimination and abuse. The number of professionals in aging
who are adept at responding appropriately to such complex navigations is
miniscule and speaks to the importance of training all those who work with older
adults not just in LGBT cultural competence, but also in sexual literacy. Efforts
to promote such sex-positive, LGBT-inclusive training on elder sexuality are
beginning to emerge, notably in the work of organizations such as the National
Sexuality Resource Center at San Francisco State University.68
68
For more information, visit the National Sexuality Resource Center website at www.nsrc.sfsu.
edu/issues/sex-and-aging. Other notable efforts in this arena: The AIDS Community Research
Initiative of America (ACRIA) provides LGBT-inclusive trainings on HIV infection in older adults
that includes information on healthy sexual activity. Gay Men’s Health Crisis (GMHC) in New
York has conducted an HIV-prevention social marketing campaign known as the “ElderSexual”
campaign.
OUTING AGE 2010
AGEISM IN LGBT COMMUNITIES
Ageism is an unfortunate fact of American life. Young people are both exploited
and held up as the standard bearers of beauty, vibrancy, and innovation—and
old people are seen as a drain on societal assets, their rich store of experiences
and skills widely ignored. While many LGBT people work to confront oppressive
behaviors and practices that harm our community, ageism is an issue that has
received relatively little notice on the list of LGBT social-justice concerns.
Feminism has had a tremendous impact on the forming of lesbian and bisexual
women’s communities in the past 40 years; these are the arenas where ageism
has been most fully explored and confronted.69 For instance, Old Lesbians
Organizing for Change (OLOC), a national advocacy group of lesbians ages
60-plus, has been a longtime leader in confronting ageism. The OLOC website
offers this forceful statement: “Old has become a term of insult and shame. To
be ‘old’ means to be ignored and scorned, to be made invisible and expendable.
We refute the lie that it is shameful to be an ‘old’ woman. We name ourselves
‘old lesbians’ because we will no longer accommodate ourselves to language
that implies in any way that old means inferior. We call ourselves old with pride.
In doing so, we challenge the stereotypes directly. Thus, we empower and
change ourselves, each other, and the world.”70
Gay and bisexual men appear to have had little connection to this dialogue,
with some notable exceptions. Writer Andrew Holleran’s 1996 novel The Beauty
of Men and Johnny Symons’s 1997 documentary film Beauty Before Age mine
this important territory. Articles in the popular and professional LGBT media
have likewise addressed the topic on occasion, but no national organization has
emerged to work consistently against ageism among gay and bisexual men.71
Ageism thus continues to have a significant impact on gay and bisexual men’s
sense of self-worth and attractiveness over the lifespan.
69
For example, see Copper, B. (1987). Ageism in the Lesbian Community. Freedom, CA: Crossing
Press.
70
“Old Lesbians Organizing for Change. About OLOC: Why Old?” Retrieved from www.oloc.org/
about/why_old.php.
71
For examples from the LGBT media, see Linscott, B. (2007, May). Generation Us. Bay
Windows; McDaniel, C. (1998, November). Gay Gerontophobia. Windy City Times; Yoakama,
J. (1999). Beyond the Wrinkle Room: Challenging Ageism in Gay Male Culture. Dimensions:
Newsletter of the Mental Health and Aging Network. In addition, Atlanta therapist John
R. Ballew summarizes several of the key issues in the following. Ballew, J. Gay Men
and Aging. Retrieved September 16, 2009, from www.thebrc.net/articles/JohnBallew/
EmotionalHealtharticles/ gay-men-and-aging.html.
37
Sandy Warshaw, New York City, 75
S
andy Warshaw has been on
both sides of the care-giving
divide, both as a caregiver and
as a care-receiver. Once a senior
staff member at SAGE (Services
and Advocacy for GLBT Elders),
Sandy, 75, has been advocating
for the recognition of LGBT aging
issues since she joined the Older
Women’s League in 1983.
In October 2008 at SAGE’s Fourth
National Conference on LGBT
Aging, Sandy spoke on a topic
near and dear to her heart: the
need to rethink and reframe the
ways in which care-giving and
caregivers have been defined, and
the political stakes for those LGBT
people and their allies. Recounting
the story of a lesbian friend,
Shirley, who had been evicted
from her home and subsequently
placed under Adult Protective
Services, she noted how the
Agency designed to “protect”
Shirley refused to acknowledge
the loved ones who helped Shirley
as care-givers because they were
not “family.” “Shirley, an only
child, whose partner of 25 years
died more than 10 years ago, had
a small but loyal support system
of friends and former professional
associates, who were mobilized
to raise funds to fend off the
first eviction attempts. One or
two friends were ‘appointed’
by Shirley to intervene with the
Agency for further social supports.
And it was here that the system
broke down. The Agency would
not communicate with the friends;
the case worker assigned would
only speak to the ‘client.’”
Sandy used her friend’s story to
highlight the ways that care giving
and care-receiving extend far
beyond heterosexual formations
of kinship. “Mainstream care
giving agencies do not understand
that ‘it takes a community’ to
support an older person, who
wants to grow old in place, not in
a potentially homophobic assisted
living or nursing home facility,
which would, incidentally, be a
more costly solution.”
Sandy notes that the economic
downturn will have especially
detrimental effects on the aging.
“The falling, failing market
will place greater hardship on
those with fixed incomes, those
without savings or retirement
plans, and those living off Social
Security and SSI benefits will face
unbelievable hardships, including
perhaps losing their homes. The
cooperation between community
caregivers and the helping
professionals is in ever greater
need.”
Always the advocate, Sandy
states that we must act now to
change the narrow parameters
of who counts as a care-giver.
“The most obvious changes
needed are in the definition of
‘family’ as designed by policy
makers, regulators and top
level administrators, and the
recognition of the role of friends
and community in care giving. As
important as marriage is, it is not
the be-all-and-end-all solution
for those growing old alone. This
fight begins with Area Agencies
on Aging, State Offices of the
Aging, and goes up to the Federal
Department on Aging.”
Most recently, Sandy has found
herself on the other side of care
giving—that is, as a care-receiver.
Recouping from an extensive
shoulder surgery, Sandy reflects
that one of the biggest obstacles
to being cared for is being
comfortable asking for help.
“I hired a neighbor to help me
with dressing and other home
chores, which have diminished
as my shoulder is healing.” She
notes also that care givers need
to take care of themselves, in
order to prevent overextending
themselves. “My experience with
friends who are or have been
caregivers, is that caregivers need
care too—a complex situation.”
OUTING AGE 2010
As this overview suggests, ageism is expressed differently
across races, genders and sexualities within LGBT
communities, but it remains a debilitating force across the
board. Although there is some evidence that lesbian and
bisexual women’s communities have created alternative
values and visions around aging that may provide a more
affirming environment for some, there is no compelling
evidence to suggest that any segment of the LGBT elder
community is immune to the ageism of the larger culture or
that within the LGBT community itself. As OLOC cofounder
Shevy Healey noted, “It really is not possible to live in this
culture and be immune to the poison of ageism. It would be
like expecting us to be free of toxins while living in a toxinfilled environment.”72
Like other
prisoners
with physical
impairments,
elders may
likewise face
particular
challenges living
in the prison
environment .
LGBT ELDERS IN PRISON
One particularly vulnerable group of LGBT elders includes
those who are part of the rapidly aging population in
correctional facilities in the United States. The most recent
statistics from the Federal Bureau of Justice indicate that
4.3% of all inmates in U.S. prisons and jails in mid-2008 were
over the age of 55, compared with 3.5% four years earlier—
a 23% increase. By comparison, the overall population in
U.S. federal and state prisons increased 7% during the same
period.73
Studies on the numbers of older prisoners who identify as
lesbian, gay, bisexual or transgender that examine their
particular concerns are few. We know, however, that as with
all older prisoners, LGBT prisoners must be able to handle
activities of daily living that go well beyond those of elders
in the community; these include being able to stand in lines
for extended periods, climb into upper bunks, or drop to
72
Healey, S. (2002). “In Her Own Words: Shevy Healey on Ageism, Aging and Selfhood.”
OutWord: Newsletter of the Lesbian and Gay Aging Issues Network, p.2. See also, Barbara
MacDonald’s classic: “A call for an end to ageism in lesbian and gay services.” Lesbian Ethics
1(1): 57-64 (1984).
73
Davidson, A. (2009, June). “The Aging Prison Population.” Retrieved from criminaljustice.
change.org/blog/view/the_aging_prison_population.
39
40
WHAT DO WE KNOW ABOUT LGBT ELDERS?
the floor when alarms sound.74 Like other prisoners with physical impairments,
elders may likewise face particular challenges living in the prison environment: a
limited numbers of cells equipped with handrails, a limited number of accessible
bottom bunks, and long walks to dining rooms and other facilities.75 Additionally,
all prisoners deemed able must work—presenting yet another difficulty for elders
who are incarcerated. As one study notes, there is no retirement age in prison.76
Scant community-based research on LGBT people’s experience of prison
indicates an increased vulnerability to violence based on sexual orientation and
gender identity. Up to 20% of inmates in men’s prisons in the United States
report being the victim of sexual assault at some point during their incarceration,
and numbers for women, though inconsistent, often range that high.77 LGBT
inmates report shocking levels of victimization. One study of California men’s
prisons found that 67% of individuals who identified as “non-heterosexual”
had been the victim of sexual assault at the hands of another inmate, a rate 15
times greater than the overall population of those institutions.78 In particular,
transgender women, gender nonconforming, and intersex people in men’s
correctional facilities suffer deplorable rates of discrimination and violence,
alongside the refusal of staff and other prisoners to recognize their gender
identity.79 Transgender prisoners report high levels of physical and sexual
abuse, humiliation, harassment, punishment and denial of basic needs like
health care.80 Correctional officers rely excessively on isolation and “protective
custody” to safeguard vulnerable inmates, despite the punitive and damaging
74
Williams, B., et al. (2006). “Being Old and Doing Time: Functional Impairment and Adverse
Experiences of Geriatric Female Prisons.” Journal of the American Geriatric Society 54(4).
75
Strupp, & Willmott. (2006). “Dignity Denied: The Price of Imprisoning Older Women in
California”. Retrieved September 24, 2009, from www.reentry.net/library/item.93566-Dignity_
Denied_The_Price_of_Imprisoning_Older_Women_in_California.
76
ibid
77
Struckman-Johnson, C., & Struckman-Johnson, D. (2000). “Sexual Coercion Rates in Seven
Midwestern Prison Facilities for Men.” The Prison Journal 80(4), p.379.
78
Jenness, V., et al. (2007). Violence in California Correctional Facilities: An Empirical Examination
of Sexual Assault. Center for Evidence-Based Corrections; Just Detention International.
(2009). A Call for Change: Protecting the Rights of LGBTQ Detainees. Retrieved from www.
justdetention.org/pdf/CFCLGBTQJan09.pdf.
79
Peek, C. (2004). “Breaking Out of the Prison Hierarchy: Transgender Prisoners, Rape, and the
Eighth Amendment.” Santa Clara Law Review 44, pp.1211-1248.
80
Sylvia Rivera Law Project. (2007). “It’s War in Here: A Report on the Treatment of Transgender
and Intersex People in New York State Men’s Prisons.” Retrieved from www.srlp.org/files/
warinhere.pdf.
OUTING AGE 2010
effects such treatment has on the very individuals it purports to protect.81
While these reports often do not provide age breakdowns for LGBT prisoner
victimization, these limited studies indicate that incarcerated LGBT elders are at
great risk for physical violence and sexual assault.
81
Stop Prisoner Rape & ACLU National Prison Project. (2005). “Still in Danger:
The Ongoing Threat of Violence Against Transgender Prisoners.”
Retrieved from www.spr.org/pdf/stillindanger.pdf.
41
42
THE WAY FORWARD
The Way Forward
G
iven the challenges outlined here, what would life look like if LGBT
people could age with respect, dignity and a sense of well-being? And
how can we move forward in advocating for the public policies and
societal changes required to make this possible? Funders for LGBTQ Issues, a
national consortium of LGBT and LGBT-friendly philanthropic foundations, offers
a clear and succinct vision for healthy aging in its groundbreaking publication
Aging in Equity. The consortium envisions a society where LGBT elders will
receive the support they need to do the following:
•
Maximize physical and emotional well-being.
•
Maintain autonomy and independence for as long as possible.
•
Age in place in their own homes, neighborhoods and communities.
•
Remain active in social and family networks.
•
Pursue social, recreational, intellectual, spiritual, and creative activities.
All elders deserve an environment where these goals are within the realm of
possibility. And while this vision seems fairly straightforward, its simplicity belies
the complex web of policies, protections and culturally appropriate programs
imperative to attaining it. Given all that we know and don’t know about the LGBT
elders and the countless barriers they face in forging a dignified and safe path
through their elder years, Outing Age 2010 focuses on moving toward making
this vision a reality for LGBT people in the United States via advocacy in five key
areas of aging-related policy:
•
Discrimination and barriers to obtaining access to services
•
Financial and family security
•
Health security — through addressing health disparities and access to care
•
Caregiving, social isolation and housing
•
Civic engagement, lifelong learning, and work
OUTING AGE 2010
DISCRIMINATION AND ACCESS TO SERVICES
A network of publicly funded services is available to support
older adults across the United States—and although it is clear
that these services are often inadequate and are increasingly
threatened in the current environment of economic crisis
and budget cutting—they at least provide a minimal safety
net for elders and their caregivers. At the same time, limited
studies and widespread experiential evidence suggest that
such services in many parts of the country provide little or no
welcome to LGBT people. Developing culturally competent
outreach and services to ensure access and ongoing support
for LGBT elders—a vulnerable population with specific needs
and concerns—has not been a priority for most agencies in
the aging network.
Even providers
who know or
suspect they
have LGBT
clients often do
not know how
to serve these
elders.
A widely cited 1994 study of Area Agencies on Aging (AAA’s),
the local agencies established to administer funds under the
federal Older Americans Act, found that 96% of the AAA’s
surveyed offered no programs specifically designed for
lesbian and gay elders; 50% reported that they believed gay
men and lesbians would not be welcome at the senior centers
funded by these AAA’s if their sexual orientation were known.82
This situation of near-total exclusion has changed somewhat
in the past decade, as a small but growing number of senior
centers and other providers funded by Area Agencies on
Aging have started offering LGBT-specific services.83 A
recent study by Quam and Croghan in Minneapolis-St.
Paul, for example, notes that while the awareness of LGBT
82
Behney, R. (1994). “The Aging Network’s Response to Gay and Lesbian Issues.”
OutWord 1(2), p.2.
83
Among the Area Agencies on Aging that offered LGBT cultural competence training or
programming in 2008 are the Atlanta Regional Commission; the Central Massachusetts Agency
on Aging; the Chicago Department of Aging Services; the District of Columbia Office of Aging;
and the Riverside County Office of Aging (Palm Springs, Calif.). Senior centers that offered
LGBT programming and services in 2008 include the Castro Senior Center (San Francisco);
the Longmont Senior Center (Longmont, Colo.); the Madison Senior Center (Madison, Wisc.);
and the Worcester Senior Center (Worcester, Mass.). These lists are based on documents in
the “Area Agencies on Aging” and “Senior Centers” subject files of the LGBT Aging Issues
Network, available to researchers at the archives of the GLBT Historical Society in San
Francisco (collection no. 2008-02); visit www.glbthistory.org.
43
44
DISCRIMINATION AND ACCESS TO SERVICES
issuesamong aging professionals has increased between 1994 and 2007;
those professionals believe that the comfort level of their LGBT clients has not
improved.84
Over the past 30 years, local and national LGBT advocacy organizations have
documented numerous barriers which our elders face in aging-services systems
that were designed for heterosexual and non-transgender clients; these barriers
include violence, legal discrimination and a lack of cultural competence.
DISCRIMINATION AND LACK OF CULTURAL COMPETENCE
Many providers of services for older adults never consider that their clients
undoubtedly include LGBT elders who have not revealed their sexual orientation
or gender identity. Even providers who know or suspect they have LGBT
clients often do not know how to serve these elders in effective and culturally
competent ways. For example, very few agencies and professionals who
serve older adults have received any training on how to diffuse and counter
homophobic or transphobic comments that one client may direct at another,
and little to no attention has been paid to addressing the assumptions and
biases held by professionals themselves. A recent review of studies of cultural
competency and homophobia among social workers found high rates of
homophobia.85
The United States Department of Health and Human Services defines cultural
competence as “a set of cultural behaviors and attitudes integrated into the
practice methods of a system, agency, or its professionals that enables them to
work effectively in cross-cultural situations.”86 For agencies and organizations,
cultural competence hinges on what is known as the five A’s of service provision:
access, availability, appropriateness, acceptability and affordability. To ensure
that they are offering culturally competent services for LGBT older adults in their
communities, providers must ask themselves the following questions:
84
Quam, J., & Croghan, C. (2007). Results of Metropolitan Aging Services Providers Study.
University of Minnesota.
85
Crisp, C. (2006). “The Gay Affirmative Practice (GAP) Scale: A New Measure for Assessing
Cultural Competence with Gay and Lesbian Clients.” Social Work.51 (2):
115-127.
86
US Department of Health and Human Services, Administration on Aging. (2008). A Profile
of Older Americans: 2008. Retrieved August 29, 2009, from www.aoa.gov/AoARoot/Aging_
Statistics/Profile/index.aspx.
OUTING AGE 2010
•
Have we effectively made LGBT older adults aware of our services?
•
Have we made our services genuinely welcoming to LGBT elders?
•
Are our services appropriate for and acceptable to LGBT older adults?
•
Are our services affordable to LGBT elders?
For professionals who work with older adults in any setting, cultural competence
makes it possible to establish positive helping relationships with clients, fully
engage clients, and improve the quality of services they receive.
In Achieving Cultural Competence: A Guidebook for Providers of Services to
Older Americans and Their Families, Douglas Kimmel and his colleagues identify
three levels of intervention to advance cultural competence.87 Key opportunities
for promoting cultural competence in serving LGBT elders exist at each of these
levels:
•
Macro-level interventions promote changes in laws, policies, and
regulations. Interventions at this level target presidential executive orders,
federal laws such as the Older Americans Act (OAA) and Title VI of the Civil
Rights Act, and the once-a-decade policy directives of the White House
Conference on Aging and the Department of Health and Human Services’
Healthy People initiative. Likewise at the macro level are interventions with
national nongovernmental organizations such as accrediting bodies for
healthcare and long-term care providers, including the Joint Commission
and the National Committee for Quality Assurance.
At this level, the OAA provides funding to the federal Administration on
Aging and the state Area Agencies on Aging to conduct research and data
collection in a variety of domains, such as nutrition, elder abuse, and elder
rights and protections. The resulting data is used to delineate vulnerable
populations and unmet needs—determinations which then drive service
plans and funding allocations. AOA’s recent announcement of funding for a
national LGBT elder resource center is a first step toward determining LGBT
elder needs and creating appropriate interventions and services.
Also at the macro level, the Older Californians Equality and Protection Act,
a California state law enacted in 2006, provides model state legislation for
creating LGBT-affirming services for elders. The act requires the California
87
Kimmel, D., et al., Achieving Cultural Competence: A Guidebook for Providers of Services to
Older Americans and Their Families. January 2001. Retrieved from www.innovations.ahrq.gov/
content.aspx?id=1578.
45
46
DISCRIMINATION AND ACCESS TO SERVICES
Department of Aging to address the needs of LGBT elders by including them
in needs assessments and area plans; providing LGBT cultural competence
training to staff, contractors, and volunteers; and ensuring that all services
are free of discrimination based on sexual orientation and gender identity.
While the passage of this legislation was an important victory, it remains an
unfunded mandate.
To date, many states and localities have passed laws forbidding
discrimination on the basis of sexual orientation—and in some cases gender
identity or expression—in public accommodations.88 Yet even where LGBT
consumers and clients are theoretically protected, enforcement of the laws—
particularly when it comes to services for older adults such as senior centers,
elder housing, and nursing homes—is often overlooked. HUD’s recent
announcement of anti-discrimination regulations in public housing provides
a macro-level statute to call upon when advocating for LGBT elders in any
publicly funded housing situation.
•
Mezzo-level interventions involve integrating community-based
organizations in the design and delivery of programs and services.
Interventions at this level target churches, schools, civic organizations, LGBT
advocacy groups, and social organizations. An exemplary intervention at
the mezzo level is the Harlem Neighborhood Program, a naturally occurring
retirement community (NORC) sponsored by SAGE in New York City. The
program brings together eight community-based partner organizations,
including a church group, advocacy groups, a senior center and a hospital to
develop and provide culturally competent services for LGBT older adults—
largely elders of color—in the Harlem neighborhood. Organizers of the NORC
also participate in a number of interagency networks and planning councils
to ensure that the concerns of LGBT older adults are represented in other
mezzo-level systems at work in the neighborhood.89 In San Francisco, the
Human Rights Commission, Castro Street Senior Center and other LGBT
groups are partnering to monitor abuses and improve services, while in San
Diego, Elderhelp of San Diego, a mainstream services provider, is teaming
with LGBT advocates to create the LGBT-affirming program, Aging as
88
Beemyn, B. (2008). The Legal and Political Rights of LGBT People. The Stonewall
Center, University of Massachusetts. Retrieved from www.umass.edu/stonewall/uploads/
listwidget/12989/LGBT%%20legal%%20rights.pdf.
89
SAGE Harlem. SAGE Harlem NORC Fact Sheet Retrieved September 16, 2009, from www.
sageusa.org/uploads/Microsoft%20Word%20-%20SAGE%20Harlem%20Neighborhood%20
NORC%20Fact%20Sheet%20-%20Jan%2008.pdf.
OUTING AGE 2010
Ourselves. Finally, The Chicago Task Force on Aging, comprised of LGBT
organizations such as the Howard Brown Health Center and the Center
on Halsted, as well as mainstream aging agencies including the Chicago
Department for the Aged and AARP Illinois, developed a needs assessment
and strategies to maximize advocacy on behalf of the city’s LGBT elders.90
•
Micro-level interventions address training for individual services providers
and professionals. Orel documents LGBT elders’ stated needs to have both
LGBT centers that are elder-affirming and senior centers that are LGBTaffirming, services that they currently lack.91 Advocates and supportive
providers have gathered countless stories of LGBT elders who have avoided
using services for fear of being treated poorly or were isolated, denied
services or discriminated against when they did ask for help or when they
needed long-term care. Although formal survey data in this area is scarce,
the anecdotal evidence is overwhelming.92
Given the breadth and depth of expertise on cultural competence that
advocates for LGBT elders have developed over the past 20 years, there
is simply no excuse for exposing LGBT elders to inappropriate, abusive,
or substandard care. Appendix B in this book provides excellent resources
on cultural competence training available to agencies, organizations and
professionals to ensure appropriate services to LGBT older adults.
90
Beauchamp, D., Skinner, J., & Wiggins, P. (2003). LGBT Persons in Chicago: Growing Older. A
Survey of Needs and Perceptions. Chicago Task Force on LGBT Aging.
91
Orel, Nancy (2006) “Community Needs Assessment: Documenting the Need for Affirmative
Services for LGB Older Adults.” In Kimmel, D., Rose, T., and David, S. Lesbian, Gay, Bisexual
and Transgender Aging: Research and Clinical Perspectives. Columbia University Press: New
York. 175-194.
92
For findings from a formal survey of skilled nursing facilities in Washington, D.C., see Faust, L.
(2003, October). DC Nursing Homes clueless on Gay Issues. Washington Blade. Retrieved from
www.washblade.com/2003/10-3/news/localnews/sengay.cfm ; Frey, Cyndee. (2000). “A Couple
with Dementia in an Assisted Living Facility.” OutWord: Newsletter of the Lesbian and Gay
Aging Issues Network, p.3, 8; Gross, J. (2007, October). “Aging and Gay, and Facing Prejudice
in the Twilight.” New York Times; Hupke, R. (2009, June). “Gay Senior Lives Less Openly in
Care Facility.” Chicago Tribune; Laing, A. (2000, Winter). “The Challenge of Finding a Home: A
Cross-Dressing Elder Veteran’s Story.” OutWord, p.2.
47
48
DISCRIMINATION AND ACCESS TO SERVICES
LGBT elders
likely have been
exposed to
hate violence at
numerous points
in their lives.
VIOLENCE: Hate Crimes
Hate-motivated violence has a tremendously detrimental
effect not only on the individual targeted; it also creates
a sense of vulnerability and insecurity across an entire
community. In particular, violence specifically motivated and
inflicted because of sexual orientation or gender presentation
has been correlated with higher rates of psychological
distress, low self-esteem, and suicidal thinking and behavior
among the victims.93
Current statistics on hate crimes against LGBT people provide
few details on the ages of the victims, making it difficult to
offer an analysis of any distinctive patterns of victimization
involving LGBT elders. The National Coalition of Anti-Violence
Programs (NCAVP) notes that community organizations
responding to anti-LGBT hate crimes typically do not gather
systematic data on the ages of the victims, focusing instead
on the type of violence, the location where it occurs, and
the relationships between the parties involved: “On a hotline
call, it is not always possible to get all the information about
the victim(s), the offender(s), the incident, etc., because the
focus of our work is supporting survivors rather than gathering
information.”94
The available data does, however, provide important
information about the experiences LGBT elders may have
had with hate crimes. The picture outlined below suggests
that most LGBT elders likely have been exposed to hate
violence at numerous points in their lives, whether personally
or through observing their friendship networks, police abuse,
or media accounts. Hate-motivated violence leaves an
indelible mark on the consciousness and sense of safety of
those who experience it. Providers of services to older adults
93
D’Augelli, A. Hesson-McInnis, M., & Waldo, C. (1998). “Antecedents and Consequences of
Victimization of Lesbian, Gay, and Bisexual Young People: A Structural Model Comparing Rural
University and Urban Samples.” American Journal of Community Psychology 26, 307-334.
94
National Coalition of Anti-Violence Programs. (2008). Anti-Lesbian, Gay, Bisexual, and
Transgender Violence in 2007. Retrieved September 16, 2009, from www.ncavp.org/common/
document_files/Reports/2007HVReportFINAL.pdf, p.10.
OUTING AGE 2010
would therefore be wise to consider the lasting impact that absorbing such
violence over the lifespan may make on LGBT elders.
According to NCAVP, a total of 2,430 hate-crimes against LGBT people in the
United States were documented in 2007, a 24% increase over 2006. FredriksenGoldsen and colleagues, add that in 2007, “LGBT-related hate crimes deaths
were the third highest ever in NCAVP’s reporting history.”95 Anti-LGBT hate
crimes are believed to be widely underreported due to a number of converging
factors, including law enforcement misconduct or disinterest, as well as the
disinclination of some victims to file complaints if they fear exposure of their
sexual orientation or gender identity.96
Demographic information gathered by NCAVP nonetheless reveals burgeoning
as well as continuing trends. The most dramatic jump from a reporting
population came from transmen (female-to-male transgender individuals,
known as FTMs), totaling 43 of the reports, a 65% increase from 2006. In fact,
288 of the reported incidents in 2007 were anti-transgender, either in full or in
part. Transgender people and other “gender nonconforming people appear
to be most frequently attacked in public settings, including bathrooms, public
assistance shelters, jails, locker rooms, and other gender-enforced spaces.”97
In cases where the gender identification of reporting victims is known, 54%
identified as male, 26% as female, 10% as male-to-female transgender (MTF),
2% as FTM, and 1% as an alternative gender.98 NCAVP notes that attackers do
not seem to differentiate between gender identification and sexual orientation—
it is gender nonconformity that motivates these attacks.99 Indeed, a recent 2007
study published in the Journal of LGBT Health Research, notes that researchers
and law enforcement “tend to conflate aspects of anti-LGB [lesbian, gay,
bisexual] prejudice and discrimination that target sexual orientation with other
95
NCAVP. (2008), p.6.
96
NCAVP reports, for instance, that “anti-LGBTQ violence has historically been poorly addressed
by law enforcement” and further, law enforcement officials continue to be one of the larger
groups of offenders against LGBT individuals.
97
NCAVP. (2008), p.8.
98
NCAVP. (2008), p.5.
99
NCAVP. (2008). LGBT Domestic Violence in 2007. Retrieved September 21, 2009, from www.
ncavp.org/common/document_files/Reports/2007%20NCAVP%20DV%20REPORT.pdf, p.5.
49
50
DISCRIMINATION AND ACCESS TO SERVICES
aspects that target gender nonconformity” and that “gender-transgressive
appearance or behavior remains widely stigmatized and targeted for violence.”100
Out of 2,500 identified hate-crime cases, the most commonly listed relationship
between the victim and perpetrator was that of strangers. However, there has
been a growth in the reported number of known assailants, such as “service
providers, law enforcement, roommates, and landlords.” In fact, this increase in
acquaintance violence can be linked with the increase of assaults occurring in
private residences, as non-acquaintances are typically denied entrance into the
home.
Finally, of the 21 LGBT people murdered in hate-motivated attacks in 2007,
more than half were people of color.101 The racial or ethnic identity of victims in
2007 greatly over-represent people of color, with 38% white; 16% Latino/Latina;
13% “African-descendant”; 3% multiracial; 2% Asian; 1% American Indian/
Alaska Native; 1% Middle Eastern/Arab; and 24% unknown.102
VIOLENCE: Domestic Violence
According to NCAVP, 3,319 incidents of LGBT domestic partner violence were
reported in 2007. The age of domestic violence victims is the least-known
variable in NCAVP statistics. Of the 2,146 callers whose age was known, 15%
were ages 50 or older: 257 were ages 50—59 (12%); 47 were ages 60—69 (2%);
and three were ages 70—79 (less than 1%). As NCAVP notes, this dearth in agerelated statistics may reflect a lack of specific outreach to LGBT elders on the
part of many of the reporting organizations.103
Be that as it may, these statistics tell us that LGBT people over 50 are indeed
at risk for current domestic violence. Additionally, given that many LGBT elders
have lived through eras of the deep closeting of the community alongside
completely unresponsive criminal justice and shelter systems, the likelihood
of elders having experienced domestic violence either personally or in their
friendship circles over the lifespan is high.
As with hate-crime statistics, LGBT domestic violence is likely to be severely
underreported. NCAVP estimates that “those who do not come forward
100 Gordan, A., & Meyer, I. (2007). “Gender Nonconformity as a Target of Prejudice, Discrimination,
and Violence Against LGB Individuals.” Journal of LGBT Health Research. 3(3). p. 56.
101 NCAVP. p.21.
102 Gordon, A., & Meyer, I. (2007). 3(3), p. 6.
103 D’Augelli, A. Hesson-McInnis, M., & Waldo, C. (1998), pp.14-15.
OUTING AGE 2010
outnumber those who do. Gender and sexuality bias in perceptions about
domestic violence may hinder reporting and responsiveness. Some providers
hold to the idea that a gendered “power dynamic” cannot exist in same-sex
relationships. Other clumsy or superficial reads of gender and power in LGBT
relationships may leave counselors or law enforcement personnel to assert that
“butch” lesbians must be abusers or “effeminate” gay men must be victims. This
can result in victims being wrongly labeled perpetrators and exposed to further
violence. Further, “Laws in some states define domestic violence as occurring
between a man and a woman; thus, some LGBT people are not afforded the
legal protections available to heterosexuals who are battered by a partner.”104
Although domestic violence often involves some sort of physical battery, NCAVP
notes that it also can encompass “verbal abuse, emotional manipulation,
isolation, depravation of food, water, or shelter, threats, or other behavior that
insults, endangers, or oppresses.”105 NCAVP likewise reports that abusers
often use a partner’s gender identity or sexual orientation as targets of their
physical and verbal abuse or to silence the victim by threatening exposure to
acquaintances, caregivers or institutional providers.106 For frail or homebound
LGBT elders who may become increasingly dependent on a partner or other
informal caregiver for help with activities of daily living, domestic violence thus
may also come to constitute a form of elder abuse.
VIOLENCE: ELDER ABUSE
Elder abuse refers to the physical, sexual, emotional, or psychological abuse of
individuals aged 65-plus by people known to them, as well as to their financial
or material exploitation, abandonment, neglect, or self-neglect.107 In 2003,
the National Research Council Panel to Review Risk and Prevalence of Elder
Abuse and Neglect reported that between one and two million older adults
were victims of elder abuse annually.108 The National Center on Elder Abuse
104 D’Augelli, A. Hesson-McInnis, M., & Waldo, C. (1998), p.116.
105 NCAVP. (2008). Sixteen Organizations, representing a number of areas, contributed to the
report: Tucson, AZ; San Francisco, CA; Los Angeles, CA; Colorado: Chicago, IL; Boston,
MA; Kansas City, MO; New York, NY; Columbus, OH; Philadelphia, PA; Houston, TX; Virginia;
Seattle, WA; and Milwaukee, WI.
106 NCAVP. (2008). p.7.
107 Sexual Violence, Elder Abuse, and Sexuality of Transgender Adults Age 50-Plus: Results of Three
Surveys. Retrieved from www.forge-forward.org/docs/APA2008_trans_elders_3surveys.pdf.
108 National Center on Elder Abuse. (2005). Elder Abuse Prevalence and Incidence Fact Sheet.
Retrieved from www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/FinalStatistics050331.pdf.
51
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DISCRIMINATION AND ACCESS TO SERVICES
Having lived in
the closet for
most of their
lives, many
of our elders
have become
accustomed to
substandard
treatment.
estimates that “for every reported incident of elder abuse or
neglect, approximately five incidents were not reported.”109
The most common perpetrators are those closest to the
elder, such as family members or caregivers.110 One study
of LGBT people found that eight percent had experienced
homophobic neglect and nine percent had experienced
financial exploitation or blackmail; nearly all of this abuse went
unreported.111
Advocates who have studied the issue believe that the preStonewall generation of LGBT elders may be at particular risk
for abuse by informal caregivers and in institutional settings.
As Sgt. Judy Nosworthy, the first LGBT liaison for the Toronto
Police Department, has noted, “For our community, elder
abuse is even more pervasive, primarily because our elders
are even more vulnerable than their hetero counterparts.
Having lived in the closet for most of their lives, many of our
elders have become accustomed to substandard treatment.
Through a lifetime of living in the shadows, many of our
seniors have learned not to ask questions, not to question
authority and [to] never, ever tell. Bluntly put, our seniors are
primed for abuse.”112
Additionally, elder advocate Loree Cook-Daniels has
observed, “those who abuse LGBT elders can also threaten
to ‘out’ someone and they can count on an LGBT elder to not
want to report abuse for fear of encountering homophobia or
transphobia. LGBT elders may also be at more risk of selfneglect, as they may refuse to obtain help in order to protect
themselves from prejudice.”113
109 D’Augelli, A. Hesson-McInnis, M. & Waldo, C. (1998), p.111.
110 New York City Department for the Aging. (2008), p.17.
111 Frazer, M. S. (2009). LGBT Health and Human Service Needs in New York State. Empire State
Pride Agenda: Albany, NY. www.prideagenda.org/Portals/0/pdfs/LGBT%20Health%20and%20
Human%20Services%20Needs%20in%20New%20York%20State.pdf.
112 Nosworthy, J. (2003, February). “Gay Elder Abuse.” GayWired.com. Retrieved from www.
gaywired.com/article.cfm?section=9&id=362.
113 Cook-Daniels, L. (1997). “Lesbian, Gay Male, Bisexual, and Transgender Elders: Elder Abuse
and Neglect Issues.” Journal of Elder Abuse and Neglect 9(2).
OUTING AGE 2010
POLICY RECOMMENDATIONS
To address the problems encountered by LGBT older adults with regard to
discrimination, culturally competent resources and services, and violence and
abuse, the Task Force recommends that the legislative bodies, governmental
agencies and private organizations, and community advocates take the
following steps:
•
Revise administrative regulations for the Older Americans Act to add lesbian,
gay, bisexual and transgender people to the list of “vulnerable senior
constituencies” with the “greatest social need” which receive particular
emphasis or attention in the allocation of federal funds.
•
Revise administrative regulations for the Older Americans Act to require state
agencies receiving funding for data collection to gather statistical information
on LGBT populations.
•
Enforce existing laws banning discrimination on the basis of age, sexual
orientation and gender identity and expression in public accommodations
with particular attention to facilities and services on which older adults rely
for care and support.
•
Pass additional state and local nondiscrimination laws as needed to ensure
that LGBT older adults have full access to facilities and services.
•
Pass state legislation modeled on the Older Californians Equality and
Protection Act to require state units on aging and Area Agencies on Aging
nationwide to include LGBT elders in needs assessments and area plans;
provide LGBT cultural competence training to staff, contractors, and
volunteers; and ensure that all services for elders are free of discrimination
based on sexual orientation and gender identity and expression.
•
Develop and institute new policies, modified case-reporting systems, and
training to give long-term care ombudsmen the tools they need to document,
address, and resolve complaints of discrimination on the basis of sexual
orientation and gender identity and expression.
•
Tie federal funding for providers of services to all older adults to certification
in LGBT cultural competence.
•
Collect data on the age of the victims when gathering of statistics on hate
crimes and domestic violence experienced by LGBT people.
53
54
FINANCIAL AND FAMILY SECURITY
•
Press for federal and state funding for outreach and services for LGBT elders
in LGBT anti-violence programs.
FINANCIAL AND FAMILY SECURITY
Anti-LGBT discrimination is built into the federal safety net for elders, and
as a result, older LGBT people are at high risk for financial insecurity in their
later years. LGBT elders facing these inequities may already find themselves
standing on a shaky financial foundation due to the economic consequences of
workplace discrimination over the lifespan.
Researcher Lee Badgett of the Williams Institute has shown that employment
discrimination against LGBT people is widespread, with gay men on
average earning at least 10% less than similarly qualified heterosexual men.
Women continue to earn seventy-seven cents on the dollar relative to men
in the workplace, while lesbian and bisexual women encounter economic
consequences due to homophobia and biphobia as well. 114 Transgender
people are particularly likely to experience high rates of unemployment and
underemployment over the course of their working lives.115
Most LGBT people who are currently ages 65-plus have spent the majority of
their working years during an era when workplace discrimination on the basis
of sexual orientation and gender identity was both socially enforced and legally
permitted throughout the United States. Job opportunities were limited, and the
jobs available to LGBT people who were open about their orientation or identity
or who had the misfortune to be exposed were less likely to include health
benefits or pensions. As a result, many LGBT older adults have low incomes and
limited assets.
114 Although workplace discrimination against LGBT people is less accepted as it once was,
there is still no federal law protecting LGBT people from such discrimination or subsequent
termination. Currently twenty states and the District of Columbia prohibit employment
discrimination based on sexual orientation; thirteen states also prohibit discrimination on the
basis of gender identity/presentation. See also Ramos, Christopher, M. V. Lee Badgett, and
Brad Sears. “Evidence of Employment Discrimination on the Basis of Sexual Orientation and
Gender Identity: Complaints Filed with State Enforcement Agencies, 1999-2007.” The Williams
Institute, UCLA School of Law, 2008. Retrieved September 21, 2009, from www.law.ucla.edu/
williamsinstitute/pdf/PACR.pdf. See also The National Gay and Lesbian Task Force’s national
mapping of the non-discrimination laws at www.thetaskforce.org/downloads/reports/issue
maps/non discrimination 7 09.pdf, retrieved December 30, 2009.
115 Grant, J., et al. (Forthcoming). Report on National Transgender Discrimination Survey. National
Gay and Lesbian Task Force Policy Institute & National Center for Transgender Equality.
OUTING AGE 2010
Since older LGBT people are half as likely to be partnered and twice as likely
to live alone as non-LGBT older adults, their sources of household income are
necessarily more limited than are those of non-LGBT elders overall.116 A recent
report by the International Longevity Center—USA and New York University’s
Wagner School of Public Service found that living alone is a significant risk
factor for poverty among older adults, especially in urban centers where the
costs of living are high.117 Among the older people who turn to providers of
services for LGBT elders, the situation is particularly acute: thirty-five percent of
SAGE’s clients, for instance, are Medicaid eligible, with annual pretax incomes
below $10,000.118
LGBT people who are married or partnered similarly face marked inequalities
which can accumulate to produce economic vulnerabilities in old age. In 2009,
only Massachusetts, Connecticut, Vermont, New Hampshire, and Iowa have
affirmed the rights of same-sex partners to marry. The federal Defense of
Marriage Act (DOMA) prevents same-sex couples from receiving federal-level
advantages such as the ability to file taxes jointly. Within this context of legal
discrimination, the Williams Institute has found that lesbian and gay “employees
with partners now pay on average $1,069 per year more in taxes than would a
[heterosexual] married employee with the same coverage.”119 A recent article by
New York Times economists Tara Siegel Bernard and Ron Lieber estimate the
added costs incurred by a hypothetical same-sex couple at between $41,196 and
$467,562, or roughly equivalent to more than three full years of their joint income.120
Although significant advances have been made in recent years towards
coverage of domestic partners in health insurance and other employment
116 Plumb, Marjorie (Unpublished). SAGE: National Needs Assessment and Technical Assistance Audit.
117 Gusmano, Michael and Victor Rodwin. (2006). “The Elderly and social Isolation.” Testimony
to Committee on Aging, NYC Council, Feburary 13, 2006. Retrieved on December 30, 2009,
from http://wagner.nyu.edu/faculty/testimony/rodwinNycCouncil021106.pdf. The International
Longevity Center—USA. Retrieved from www.ilcusa.org/media/pdfs/ElderlyandScialisolation.pdf
118 Thurston. (Forthcoming). Services and Advocacy for GLBT Elders (SAGE). Journal of Long
Term Home Health Care.
119 Ash, & Badgett. (2006). “The Financial Impact of Domestic Partner Benefits in New Hampshire.”
The Williams Institute on Sexual Orientation Law and Public Policy, UCLA School of Law.
Retrieved September 23, 2009, from www.law.ucla.edu/williamsinstitute/publications/
NHDPBenefitsEconImpact2006.pdf, p.1.
120 Siegel Bernard, T., & Lieber, R. (2009). “The High Price of Being a Gay Couple.” New York
Times, 2 October 2009. Online. Accessed December 30, 2009, at http://www.nytimes.
com/2009/10/03/your-money/03money.html
55
Marvin Burrows Haywood, California, 73
grandma, and soon, with Bill and
his mother.”
In 1966, Marvin and Bill moved
to California, and by 2000, the
couple had been together for
over 46 years. “When California
allowed domestic partnerships,
we did that. And in 2004, when
they passed the gay marriage
law, we got married, but it was
declared ‘null and void’ six
months later.”
W
hen Marvin tells people
that he and his life-long
partner, William Blaine Swensor,
were together for over 50 years, it
never fails to elicit a “Wow!” from
listeners. But for Marvin, “It just
wasn’t enough time.”
Born in Flint, Michigan in 1936,
Marvin lived in the country and
would ride the bus into town to
his job in a department store. One
day while waiting for the bus, one
of his friends drove by, recognized
him and pulled over to offer him
a ride. “I waved and poked my
head into the passenger side
window, and sitting in front was
this tall, really good looking guy,
and I crawled into the back and
couldn’t take my eyes off of him.”
Marvin and Bill, then 15 and 17
respectively, lived close to each
other, and Marvin would bike over
to see Bill every day. “Eventually
my Dad found out about our
relationship and told me to either
get rid of Bill or get out of the
house. But I was already so head
over heels that I moved in with my
Bill passed away in 2005. Marvin
was beside himself with grief. “He
was the healthy one! He had just
played golf that morning. It was
difficult, and I barely coped. Life
just sort of became a white noise.
My doctor prescribed me antidepressants and sleeping pills, so
I was sleeping a lot.”
Still in the throes of bereavement,
Marvin was facing homelessness
and loss of his health insurance.
“Bill worked for a glass company
called Owens-Illinois for 36 years.
Thirty-six loyal years. But when
he passed, I was denied his
pension benefits and also lost
my health coverage because it
was only through Bill’s work that
we could afford it. So here I was,
depressed, barely functioning,
and then I find that I was about
to lose my house because even
though we paid the rent every six
months, I knew I couldn’t afford it
on my own.”
When he approached OwensIllinois about receiving Bill’s
pension benefits, “their first denial
was almost immediate. I knew
there was no way I could get his
Social Security benefits, but I
appealed to the Union again, and
was rejected. I called the National
Center for Lesbian Rights (NCLR)
and spoke with their lawyers, and
they wrote letters to the O-I Union
on my behalf, but were denied
twice.”After three long years,
Marvin finally got his husband’s
pension benefits. “It was so weird.
Kate Kendall at NCLR was the
one who called me, and I was just
shocked, stunned. She told me,
‘This is the best call I have made
in over a year.’ ”
“The first time I ever spoke about
it was in front of the California
Legislature. I testified about my
experiences and it just sort of
snowballed from there. I kept
speaking out about it, to the
Senior Outreach Director for
Marriage Equality USA in Oakland,
to the Beverly Hills Task Force
chapter, Equality California, and
to any agencies concerned or
interested in aging issues.” While
initially, Marvin was advised not
to mention the Union or pension
plan by name, the more he spoke
out, the more it helped his cause.
“Eventually, not only did they
give me Bill’s pension, but they
also allowed for the retroactive
reinstatement of these benefits as
well.”
“I think it really took three things:
myself speaking out; NCLR; and
support from Bill’s fellow union
members.”
OUTING AGE 2010
benefits in the private sector and in some state and local governments, these
advances have not rectified many of the financial inequalities between oppositesex married couples and same-sex couples. For both coupled and single LGBT
older adults, the economic effects of discrimination across the lifespan combine
with the inequalities inscribed in federal policy to create something of a perfect
storm of financial insecurity, leaving them at higher risk for poverty while at
the same time excluding them from critical safety-net programs such as the
following:
SOCIAL SECURITY SPOUSAL BENEFITS
Social Security spousal benefits allow an elder receiving retirement benefits to
claim a larger payment based on the qualifications of the elder’s opposite-sex
spouse if the spouse has a higher income history; these benefits are available
even to divorced opposite-sex spouses if their marriage lasted at least 10 years.
No matter how long they have been partnered or married, same-sex couples
are denied this support.121 Spousal disability benefits and veteran’s benefits also
are not available to same-sex partners. Transgender spouses may or may not
receive benefits, depending on the legal status of their marriages.
Legal scholar Nancy Polikoff notes that the current Social Security system
privileges single-earner married couples over dual earning married couples
with similar salary bases. In effect, all workers in the system subsidize singleearner households based on the needs and configuration of “family” that was
popular when the Social Security Administration was founded in 1939, with an
opposite-sex husband supporting a non-wage earning wife. Polikoff argues that
LGBT advocacy is better directed at creating a “base level benefit” for all older
Americans rather than arguing for an improved safety net for a limited number
of LGBT people through the extension of same-sex marital benefits under the
current system.122
121 Dubois, Matthew R. “Legal Concerns of LGBT Elders.” Lesbian, Gay, Bisexual, and Transgender
Aging: Research and Clinical Perspectives. Eds. Douglas Kimmel, Tara Rose, and Steven David.
New York: Columbia University Press, 2006. 195-205.
122 The Urban Institute’s Social Security reform work also foregrounds this perspective. Polikoff’s
challenging and well-reasoned analysis can be found in Polikoff, N. (2009). Beyond (Straight
and Gay) Marriage: Valuing All Families Under the Law. Boston: Beacon Press. Also see
Wheaton, L. (1998). Low-Income Families and the Marriage Tax. Urban Institute. Retrieved
from www.urban.org/UploadedPDF/marriage_tax.PDF Also see Steuerle, C. E. The Widespread
Prevalence of Marriage Penalties, Testimony Before the Subcommittee on the District of
Columbia, Committee on Appropriations, United States Senate. Urban Institute. Retrieved from
www.urban.org/UploadedPDF/900952_Steuerle_050306.pdf.
57
58
FINANCIAL AND FAMILY SECURITY
SOCIAL SECURITY SURVIVOR BENEFITS
As Outing Age first reported in 2000, Social Security survivor benefits are denied
to same-sex partners: “While widows and widowers or even divorced spouses
can count on a portion of the deceased’s Social Security income, this does not
apply to non-married partners no matter how many years they may have lived
with and supported their partner.”123 For same-sex couples who have legally
married in the several states where that is now possible, exclusion from these
survivor benefits is formally codified under the federal Defense of Marriage Act.
Social Security discrimination costs LGBT older adults an estimated $124 million
a year in lost benefits.124 One LGBT services provider noted that “gay elders who
have worked hard to contribute to Social Security and who may have created
a family or had children do not receive the same benefits as their heterosexual
counterparts and need to engage in specialized estate and retirement planning
to protect themselves as they age.”125
Additionally, LGBT people without partners would not be in a position to
transmit or rely on survivor benefits, even if such benefits were ultimately to be
made available to legally married same-sex couples. Given that limited research
suggests that LGBT people may be significantly more likely than heterosexual
and non-transgender people to age without partners, the current structure of
Social Security benefits fails to recognize the ways that LGBT people create
kinship through chosen families or whom we might consider survivors.
123 Cahill, S., South, K. & Spade, J. (2000). Outing Age: Public Policy Issues Affecting Gay,
Lesbian, Bisexual and Transgender Elders. Washington, DC: National Gay and Lesbian Task
Force Policy Institute. Retrieved June 22, 2009, from www.thetaskforce.org/pub.html, p.43.
124 Ibid.
125 Dubois, Matthew R. (2006).
OUTING AGE 2010
MILITARY AND VETERANS BENEFITS
Social Security discrimination is not the only area where LGBT
people receive unequal family benefits. LGBT individuals
whose deceased partners served in the United States Armed
Forces also are ineligible for federal benefits and certain state
benefits granted to the surviving spouses of active service
members and of veterans. Despite the efforts of the U.S.
military since World War II to exclude LGBT people, many
LGBT elders have honorably served in uniform—yet find
their partners in old age cut off from the financial security
represented by survivor benefits. Data from the 2000 Census
on same-sex couples showed a high prevalence of military
veterans among Black lesbian couples, indicating that Black
LGBT people may be disproportionately impacted by antiLGBT veteran’s policies.126
59
Black LGBT
people may be
disproportionately
impacted by
anti-LGBT
veteran’s policies.
MEDICAID LONG-TERM CARE BENEFITS
To qualify for Medicaid payments for long-term care, an
individual must have significantly reduced income and
assets, which means that elders who own their own homes
but have limited incomes are sometimes faced with selling
their homes and spending down their assets before they can
qualify for needed benefits. Married couples, however, are
protected from this eventuality: when one spouse requires
long-term care but the other does not, the couple’s principal
residence is excluded from the asset inventory, thus enabling
the community spouse to continue living in the jointly-owned
home.127
Although a number of states have legalized same-sex
marriages or recognize such marriages performed elsewhere,
DOMA denies these marriages recognition by the federal
126 Dang, A. & Frazer, M. S. (2005).
127 In Beyond (Straight and Gay) Marriage, legal scholar Nancy Polikoff notes that in some cases,
marriage is a disadvantage to elders seeking to protect their assets. For example, if an LGBT
elder with few assets requires long-term care but is partnered with an elder possessed of
significant assets, being unmarried protects the economically advantaged partner from having
to spend down all of his/her assets to care for the partner. Elders of any sexual orientation
facing a long-term care situation are at times counseled against marriage for this reason.
60
FINANCIAL AND FAMILY SECURITY
government. As a result, same-sex married couples are excluded from the
protections offered to opposite-sex married couples under the Medicaid
program. A same-sex married couple who jointly owns a home may therefore be
forced to sell the home if one of the spouses needs to meet the assets test to
qualify for Medicaid long-term care payments.128
LGBT organizations and allies are in the midst of a campaign to repeal DOMA,
and the Obama Administration has voiced its support of these efforts. A repeal
of DOMA, however, would make same-sex married couples eligible for Medicaid
benefits extended to married couples only in states where their marriages are
recognized. This is because Medicaid, although federally funded, relies on state
law to determine eligibility and spousal status. If a married same-sex couple
relocated to a state that does not recognize such marriages, the couple would
not be able to qualify for Medicaid as a married couple.
Even though DOMA currently prohibits same-sex married couples from being
considered spouses for Medicaid eligibility, Vermont and Massachusetts have
found a way to protect the jointly owned homes of married same-sex couples
by paying them Medicaid long-term care benefits through a separate funding
mechanism supported exclusively by state funds. In the absence of DOMA
repeal, this is a state-level intervention to note.
PENSIONS
In 2006, Congress passed the Pension Protection Act, making it possible for
unmarried individuals to inherit proceeds of a deceased associate’s pension
savings without triggering an immediate tax penalty and without raising the
beneficiary’s tax bracket. The Act also protects hardship withdrawals on behalf
of non-spouses and non-dependents for such emergencies as medical costs,
tuition or funeral expenses. This legislation models an innovative approach to
support for LGBT elders: It provides recognition not only for those who are in
partnerships, but also for those who rely on families of choice by creating a
framework permitting married, partnered or single elders to designate a nonspouse beneficiary to draw on or inherit their assets without incurring a tax
penalty.
128 National Center for Lesbian Rights. (2009). Planning with a Purpose: Legal Basics for LGBT
Elders. Retrieved from www.nclrights.org/site/DocServer/PlanningWithPurpose_Web.
pdf?docID=6121.
OUTING AGE 2010
HOSPITAL VISITATION AND END-OF-LIFE DECISION-MAKING
Finally, it should also be noted that because LGBT couples in most cases
are not legally recognized, hospital visitation policies may exclude same-sex
partners or other family, impeding or complicating critical health decisionmaking processes.129 LGBT elders are especially vulnerable to having their endof-life preferences for care denied or dismissed. “Spouses and some biological
relatives automatically receive authority for some decisions; life partners,
children of life partners, or other nontraditional family members do not,” notes
Elder law attorney, Matthew R. Dubois, who adds that “most state and federal
laws regarding incapacitated and disabled people place [legally married]
spouses and biological family ahead of actual or chosen family.”130
As a consequence, when a lesbian, gay, bisexual or transgender elder who
has a partner is incapacitated or dies, the elder’s partner may not be able to
enforce the elder’s directives regarding health and hospice care, funeral plans,
inheritance and other end-of-life issues. To overcome this obstacle, elders must
take on the expense and inconvenience of obtaining durable power of attorney
for healthcare and other legal documentation authorizing their partners to ensure
that their wishes are honored. One example of such documentation pertaining to
issues of property is a will stating that the partner “is to be treated as if he or she
were a married spouse for purposes of succession.”131
End-of-life planning is equally important for transgender elders: As Dubois
observes, “The length of time spent [post-transition], administrative law
proof requirements, and the jurisdictional quirks of state law in the areas of
personal identification, name change, and family law often affect the rights of
the transgender elder.”132 Indeed, marrying a person of the opposite sex after
transitioning often places transpeople in legally murky territory. Several court
cases have invalidated the marriages of transwomen who have subsequently
129 National Center for Lesbian Rights. (2009). Planning with a Purpose: Legal Basics for LGBT
Elders. See also Lambda Legal Defense and Education Fund’s lawsuit on behalf of the family of
Lisa Pond and Janice Langbehn who suffered the loss of Lisa while on vacation in Miami/Dade
County, which failed to recognize Janice as a partner in the hospital setting, despite having
completed medical power of attorney documents before the crisis. After Lisa’s death both the
State of Florida and the Dade County Medical Examiner refused to release her death certificate
to the family for purposes of life insurance and Social Security benefits for her children.
www.lambdalegal.org/in-court/cases/langbehn-v-jackson-memorial.html.
130 Dubois, M. (2006).
131 Dubois, M. (2006), p.202.
132 Dubois, M. (2006), p.203.
61
62
HEALTH
married men, denying the surviving spouse the legal benefits of received by
heterosexual surviving spouses.133
POLICY RECOMMENDATIONS
To address financial insecurity among LGBT elders, The Task Force calls on
legislative bodies, governmental agencies, private organizations, and community
advocates to take the following steps:
•
Institute legislative and regulatory changes to reframe and expand the
definition of family to recognize same sex relationships and LGBT family
kinship structures in the designation of federal benefits such as Social
Security, Medicaid and Veterans Benefits.
•
Enact legislation to ensure that all Americans have access to affordable,
quality health care.
•
Collect and report data on sexual orientation and gender identity via the U.S.
Census and in all federally funded research.
•
Pass a federal law to ban employment discrimination on the basis of sexual
orientation and gender identity and expression. Where they do not currently
exist, pass equivalent state and local laws.
•
Enforce existing laws banning discrimination on the basis of sexual
orientation and gender identity and expression in employment as a key step
toward ending the lifelong income inequalities that result in greater financial
vulnerability for LGBT elders.
•
Repeal the Defense of Marriage Act and same-sex marriage prohibitions at
the state level.
•
Overturn Don’t Ask, Don’t Tell, which stigmatizes and targets LGBT service
members for discharge based on their sexual orientation.
133 Blevins, D., & Wirth Jr,. J. L. (2006).
OUTING AGE 2010
HEALTH
Health disparities—gaps in the quality of health and health care across differing
demographic groups—have become an increasing focus of public discussion
and policy advocacy in the United States. While addressing racial, ethnic and
gender gaps in health outcomes has become a public health priority over the
past 10 years, health disparities among LGBT people remain largely invisible
and widely ignored. Because most health problems occur in later life, the lack of
attention to such disparities is of particular concern for LGBT elders.
The lack of attention to the distinctive health concerns of LGBT people of all
ages is evident in such initiatives as the department of Health and Human
Service’s key health policy agenda, Healthy People 2010, which established
a 10-year plan for improving the nation’s health in 2000. Despite identifying
LGBT people as vulnerable to health disparities, a midcourse review examines
disparities by race and ethnicity, income or education, and gender (as well as
in some cases, geography or disability) but not sexual orientation or gender
identity.134 Similarly, the National Healthcare Disparities Report does not examine
any differences between LGBT and non-LGBT people.135 Such differences
nonetheless have been documented: a recent study found that LGBT people
experience health disparities on seven of the leading Healthy People 2010
indicators.136
Health disparities are of additional concern to elders because they not only may
be the result of poor current health care, but also may reflect the consequences
of poor health and lack of access to care over the lifespan. A lesbian, gay,
bisexual or transgender elder experiencing difficulty obtaining care may
have health problems that reflect many years of inadequate care, preventive
screenings, and other needed services. While few national or state studies
focus on health disparities among LGBT elders, findings from community-based
research on LGBT health disparities overall have significant implications for older
populations.
134 US Department of Health and Human Services, Office of Disease Prevention and Health
Promotion. (2005). Healthy People 2010. Retrieved from www.healthypeople.gov/data/.
135 Acquaviva, Kimberly. “Re-Defining Health Care Disparities for LGBT Older Adults (and for all
Seniors).” Diversity and Aging in the 21st Century: Let the Dialogue Begin. Edited by Percil
Stanford. Washington, DC: AARP Press, 2009.
136 Mayer, Kenneth, et al. “Sexual and Gender Minority Health: What We Know and What Needs to
Be Done.” American Journal of Public Health. 98.6 (2008): 989-995.
63
64
HEALTH
ACCESS TO HEALTH CARE
Limited studies suggest that LGBT people in the United States use health care
less often than non-LGBT people. Contributing factors best documented by
research include lower rates of health insurance, as well as experiences of
homophobia and ignorance of LGBT issues among healthcare professionals.
However, these problems do not fully explain underutilization of primary care
and cancer screenings, differential mental health outcomes, or disparities in
chronic disease risk factors among LGBT people.
Even fewer studies have addressed issues of healthcare access for specific
groups within the LGBT population such as people of color, residents of rural
areas, bisexuals, and transgender and gender-nonconforming people.137
Healthcare access among LGBT elders is particularly understudied, although
there is no reason to believe that data for elders would reflect a greater degree
of access than is documented among the general LGBT population.
PROBLEMS WITH HEALTHCARE ACCESS: Lack of Insurance
Lack of health insurance is a serious problem across the United States, with
18,000 preventable deaths attributed to this cause every year.138 Among aging
LGBT people, the issue is of particular concern to those under age 65, who are
not yet old enough to qualify for Medicare. The one population-based study to
break out health insurance coverage by sexual orientation included only people
ages 18—44, but there is little reason to believe that rates of coverage would be
substantially higher among those ages 45—64. The research found that 18.9%
of heterosexual males and 14.8% heterosexual females lacked health insurance,
as did 10.9% of bisexual males, 26.7% of bisexual females, 27.2% of gay men,
and 15.2% of lesbians.139 Studies using convenience samples have produced
137 Miller, M., Andre, A., Ebin, J. & Bessonova, L. (2007). Bisexual Health, An Introduction and
Model Practices. Washington, DC: National Gay and Lesbian Task Force Policy Institute,
Fenway Institute, & BiNet USA. Retrieved August 18, 2009, from www.thetaskforce.org/
downloads/reports/reports/bi_health_5_07_b.pdf.
138 Institute Of Medicine. (2004). Insuring America’s Health. Retrieved September 21, 2009, from
www.iom.edu/CMS/3809/4660/17632.aspx.
139 US Centers for Disease Control and Prevention. (2005). “Sexual Behavior and Selected Health
Measures: Men and Women 15—44 Years of Age.” Washington, DC. Retrieved September 21,
2009, from www.cdc.gov/nchs/data/ad/ad362.pdf.
OUTING AGE 2010
similar findings.140 Unmarried couples, whether same-sex or opposite-sex, are
two to three times more likely to be uninsured.141
Individuals in the United States ages 65 and older are covered by Medicare,
provided they are citizens and have worked and paid income taxes for 10 or
more years. Those who have worked for less time pay premiums to buy into
Medicare. Original Medicare, which covers hospital insurance at no cost and
medical insurance for a fee, leaves high out-of-pocket expenses to be covered
by beneficiaries.142 Medicare Part D, which provides prescription drug insurance,
is administered by private providers; Medicare Part C bundles all three and is
administered by private providers. Both Part D and Part C also involve out-ofpocket expenses.
Few providers are trained or experienced in LGBT-specific health care,
so provider choice can be a very important access issue for LGBT elders.
Under Original Medicare, LGBT elders are constrained by the limited number
of providers willing to accept the fees set by the program. If an individual
is covered by Medicare Part C, choice is controlled by the relevant health
maintenance organizations (HMOs), and access to culturally competent care
may once again be inadequate. In addition to Medicare, some LGBT elders
also may receive healthcare coverage from current employers—or if they are
retired, from former employers. They also may buy supplemental insurance
(so-called Medigap coverage) under private plans designed to address gaps in
Original Medicare—or may be eligible for additional means-tested government
programs.
LGBT elders who have been honorably or generally discharged from the United
States Armed Forces also are eligible for certain healthcare benefits from the
Veterans Health Administration. Veterans are not constrained by the anti-LGBT
“Don’t Ask, Don’t Tell” policy applied to active-duty service members and
cannot be deprived of care on the basis of sexual orientation or in most cases
on the basis of gender identity, yet concern about the policy may nonetheless
lead veterans to fear discrimination or loss of benefits if they reveal their sexual
orientation or gender identity in medical settings. Such fears can leave LGBT
140 See review in Mayer, K. H., et al. (2008), pp.989-995.
141 Ash, & Badgett. (2006).
142 Original Medicare refers to the combination of Medicare Part A (hospital coverage) and Part B
(medical coverage). Part A requires no payment, but most people must pay monthly premiums
under Part B. For details, see the Medicare website: www.medicare.gov/choices/Overview.asp
(click on the “Original Medicare” link).
65
Denny Meyer New York City, New York, 62
A
Baby Boomer, Denny Meyer
recalls that he was always
taught that “there is nothing
more precious than American
Freedom.” Growing up in New
York City as a child of Jewish
Holocaust refugee parents,
his mother, an undocumented
immigrant, taught him to be proud
of who he was. Denny never
considered joining the military,
and his parents expected him to
become a lawyer or doctor. As
a child of the 1960s, however,
coming of age during the antiVietnam War protests he saw
protestors burning the American
flag and thought, It’s time to pay
my country back for taking them
in when they were war refugees.
He joined the US Navy in 1968,
and later he served for years in
the Army Reserve, becoming a
Sergeant First Class.
During his tenure in the armed
forces from 1968 until 1978,
Denny said, “Life was extremely
difficult, both for hiding who I was
as a gay man, and also due to
being the only Jew in my military
environment.” Already “out” in
college and a good twenty-five
years before “Don’t Ask, Don’t
Tell,” Denny notes that when
he enlisted, he went “back into
the closet” because he knew
queers were not allowed to serve.
Interestingly, back then he notes,
“No one expected homosexuals
to be in the military so there
wasn’t a constant vigilance to
spot us.” Rather, “Homophobic
commentary was simply a part
of the ‘normal’ male-only banter
during most of the time that
I served. We said nothing; in
fact we had to laugh along with
everyone else to fit in. It hurt
terribly, but this was before ‘gay
rights’ and so there were no
thoughts of experiencing anything
better.” Simply the perception that
someone was gay could get them
killed. Indeed, Denny noted the
case of Barry Winchell who was
brutally killed in 1999 by a fellow
private who thought Winchell was
gay; he was not, Barry was the
significant other of a transwoman.
Despite the foreboding
atmosphere, Denny went onto
serve a total of ten years in the
Navy and Army, achieving the
rank of Sergeant First Class.
Now Denny is a national activist
advocating the repeal of “Don’t
Ask, Don’t Tell,” a policy that has
made it more difficult for LGBT
people serving in the Armed
Forces. “When I served from
1968-78, a gay person could
simply ‘pass for straight’ without
much difficulty or suspicion. After
the DADT law was implemented
in 1993, everyone was a suspect;
anyone who was intellectual,
musical, dressed neatly or had a
photo in his locker with his arm
around his uncle was suspected
of being gay.”
Most recently, Denny started the
New York chapter of American
Veterans for Equal Rights in 2003
after receiving a homophobic
response receiving services from
the Veterans Administration. The
VA has no policy of discriminating
against LGBT veterans, but,
“on the other hand, there is no
VA policy protecting LGBT vets
from discrimination. Out of the
fear of discrimination, older
gay and lesbian vets generally
do not disclose their sexual
orientation at the VA out of a
mistaken fear of losing benefits.
Many transgendered veterans
have been denied health care,
even for treatment not related
to transitioning.” This failure
to fully disclose, as well as the
general fear of discrimination or
harassment, remains one of the
greatest barriers in LGBT persons
receiving proper and personalized
care at VA health clinics.
OUTING AGE 2010
veterans vulnerable on many fronts, causing them to avoid
care or fail to disclose important health concerns. Veterans
worried about self-disclosure likewise may feel constrained
to distance themselves in the healthcare setting from samesex partners or LGBT chosen family who could otherwise
provide invaluable support. Furthermore, one small-scale
study has documented discrimination and formal barriers to
gender-related care faced by older transgender veterans in
the Veterans Health Administration.143
LGBT people
are less likely to
have insurance
and a regular
source of care.
Research suggests that LGBT people are less likely to have
insurance and a regular source of care; although data in
previous studies is not broken out by age, it is logical to
assume that a lifetime in this position will have a negative
impact on LGBT elders overall.144 There are many possible
reasons for insurance disparities. For example, because
LGBT individuals in most jurisdictions are not covered under
health insurance offered by a same-sex partner’s employer,
many in same-sex couples who would otherwise be insured
are not. This is a particular concern for coupled LGBT people
in midlife who are not yet retired from the workforce and are
not yet eligible for Medicare.
Research by the Aging-in-Place Initiative of the United
Hospital Fund found that participants in SAGE’s Harlem
Naturally Occurring Retirement Community (NORC) project
were younger than participants in other NORCs, and thus
less likely to have health insurance or the means to pay
for prescription medications and more likely to use the
emergency room as their primary source of healthcare
services. Although they had lower self-perceived needs for
143 Helms, Monica. “Transgender U.S. Veterans Ages 56-Plus Report Difficulties with VA
Healthcare.” OutWord. American Society on Aging LGBT Aging Issues Network. http://www.
asaging.org/asav2/lain/enews/08fall-09win/medical_care.cfm. Accessed December 23, 2009.
144 Kerker, Bonnie, Farzad Mostashari, and Lorna Thorpe. “Health Care Access and Utilization
among Women Who Have Sex with Women: Sexual Behavior and Identity.” Journal of Urban
Health. 83.5 (2006): 970-979.
67
68
HEALTH
diabetes and blood pressure maintenance, their emergency room visits were
largely due to mismanaged diabetes or respiratory issues.145
We have little national data on health insurance access for transgender people,
but a review of needs assessments of the female-to-male (FTM) transgender
community found high levels of difficulty obtaining care; for example, 42% of
FTMs in Los Angeles reported such problems. 146 In these studies of FTMs,
between 58% and 82% were insured, compared with 84% of the general
population.147 A large needs assessment conducted by the Transgender Law
Center in San Francisco found that nearly one-half of survey respondents lacked
any kind of health insurance coverage. Eleven percent of participants in the
study were ages 51-plus, but the data regarding insurance and health care are
not broken out by age.148
Similarly, an examination of data from a population-based sample of New York
State residents found that one-third of transgender people lacked insurance,
while only 15% of non-transgender people did.149 The Transgender Law Center
reports that health insurance coverage does not always translate into access to
health care for transgender people. Financial barriers and denials of coverage
result in many transgender people putting off basic health care needs. Even
when covered by insurance, 42% of respondents delayed seeking care because
they could not afford it and 26% reported health conditions that worsened
because they have postponed care.150
145 United Hospital Fund Aging in Place Initiative. (2009). “Health Care Indicator Survey in Naturally
Occurring Retirement Communities.” Retrieved September 21, 2009, from www.uhfnyc.org/
initiatives/aging-in-place.
146 Rachlin, K., Green, J., & Lombardi, E. (2008). “Utilization of Health Care among Female-To-Male
Transgender Individuals in the United States.” Journal of Homosexuality. 54.3 (2008): 243-258.
147 Rachlin, K., Green, J., & Lombardi, E. (2008); Employee Benefit Research Institute. Current
Population Survey, March 1988-2007 Supplements.
148 Minter, S., & Daley, C. (2003). “Trans Realities: A Legal Needs Assessment of San Francisco’s
Transgender Communities.” San Francisco: National Center for Lesbian Rights, & Transgender
Law Center. Retrieved September 16, 2009, from transgenderlawcenter.org/trans/pdfs/
Trans%20Realities%20Final%20Final.pdf.
149 Frazer, M. S. (2009). LGBT Health and Human Services Needs in New York State. Empire State
Pride Agenda Foundation. Retrieved October 1, 2009, from www.prideagenda.org/Portals/0/
pdfs/LGBT%20Health%20and%20Human%20Services%20Needs%20in%20New%20
York%20State.pdf.
150 Transgender Law Center. (2009). State of Transgender California, March 2009. Retrieved
October 14, 2009, from www.transgenderlawcenter.org/stateoftranscafinal.pdf.
OUTING AGE 2010
Even LGBT people in same-sex partnerships who can use state marriage laws
or state domestic partnership and civil union laws to obtain coverage under their
partners’ insurance face a financial disparity: They must pay federal taxes on
the health insurance premiums because their relationships are not recognized
as marriages by federal law. Unmarried same-sex couples have lower rates of
health insurance than married same-sex couples, although they are more likely
to have health insurance than unmarried opposite-sex couples.151
Poor people, immigrants and people of color are much more likely to be
uninsured than their non-poor and white counterparts.152 In 2006, for example,
34.1% of Hispanic people, 20.5% of Blacks surveyed, and 15.5% of Asian
respondents reported not having any form of health insurance coverage as
opposed to 10.8% of non-Hispanic White respondents. In the absence of
data specifically addressing the extent of insurance coverage among LGBT
immigrants, people of color and poor people, we are no doubt justified in
thinking that the coverage for LGBT people in these groups will be no better
than for the general population.
PROBLEMS WITH HEALTHCARE ACCESS:
Negative Experiences and Fear of Stigma
Barriers to health care for LGBT older adults go beyond the financial constraints
created by limited or absent insurance coverage. Even countries with universal
healthcare find that LGBT people of all ages experience barriers to care.153
Because many LGBT people fear discrimination or have had past negative
experiences with healthcare providers, they may avoid disclosing important
details of their health and risk factors to clinicians or may avoid health care
151 Ash, Michael, and M.V. Lee Badgett. “Separate and Unequal: The Effect of Unequal Access
to Employment-Based Health Insurance on Same-Sex and Unmarried Different Sex Couples.”
Contemporary Economic Policy. 24.4 (2006): 582-599. Also available at The Williams Institute’s
website at: http://www.law.ucla.edu/williamsinstitute/publications/HealthInsuranceInequality.
pdf. Accessed January 4, 2010.
152 DeNavas-Walt, C., Proctor, B., & Smith, J. (2007). “Income, Poverty, and Health Insurance
Coverage in the United States 2006.” US Census Bureau, Current Population Reports.
Washington, DC: United States Government Printing Office. Retrieved from www.census.gov/
prod/2007pubs/p60-233.pdf.
153 Scott, S., Pringle, A., & Lumsdaine, C. (2004). “Sexual Exclusion, Homophobia and Health
Inequalities: A Review. UK Gay Men’s Health Network.” Retrieved September 21, 2009,
from www.docs.google.com/gview?a=v&q=cache:PdpHQFT9DDsJ:www.healthfirst.org.uk/
documents/gmhn_report.pdf+Scott,+S.,+Pringle,+A.,+Lumsdaine,+C.+%282004%29.+Sexual+
Exclusion,+Homophobia+and+Health+Inequalities:+A+Review.&hl=en&gl=us.
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altogether.154 Such fears may be a particular concern among LGBT older adults
who spent much of their earlier adult lives during an era when medical and
mental health professionals routinely stigmatized homosexuality and gender
nonconformity as illnesses meriting harsh interventions.
Although there has been considerable positive change in the healthcare field
in recent years, LGBT elders’ ongoing concerns about how they will be treated
by providers are not unfounded: Many healthcare professionals do not have
adequate knowledge of LGBT people’s specific health concerns or sensitivity to
the prejudice that LGBT people face, nor do they consistently ask about sexual
orientation or gender identity during visits.155 A recent report from the New
York City Public Advocate exposes this lack of training, noting that in the city’s
healthcare facilities, “LGBT individuals experience hostility and discrimination
in care.” The report adds that “concerns about homophobia and transphobia
keep LGBT individuals from using healthcare services.”156 Studies of lesbian and
bisexual women likewise find that they report high levels of negative interactions
with doctors and other providers and a high level of dissatisfaction with health
care.157
In the Task Force/NCTE National Transgender Discrimination Study, one-quarter
of respondents age 65 and over reported that they had delayed or avoided
needed or preventative medical care because of disrespect or discrimination
in medical settings.158 In the State of Transgender California report, 30% of
respondents stated they postponed care for illness or preventative care due to
154 Bonvicini, Kathleen, and Michael Perlin. “The Same but Different: Clinician-Patient
Communication with Gay and Lesbian Patients.” Patient Education and Counseling Journal.
51.2 (2003): 115-122.
155 Dahan, Rachel, Rotem Feldman, and Doron Hermoni. “Is Patients’ Sexual Orientation a Blind
Spot of Family Physicians?” Journal of Homosexuality. 55.3 (2008): 524-532; and: O’Hanlan,
Katherine, Robert Cabaj, Benjamin Schatz, James Lock, and Paul Nemrow. “A Review of the
Medical Consequences of Homophobia with Suggestions for Resolution.” Journal of the Gay
and Lesbian Medical Association. 1.1 (1997): 25-39.
156 Public Advocate for the City of New York. (2008). Improving Lesbian, Gay, Bisexual, and
Transgender Access to Healthcare at New York City Health and Hospital corporation Facilities.
Retrieved from pubadvocate.nyc.gov/policy/documents/LGBThealthrecsreportfinal_pdf.pdf.
157 Stevens, Patricia. “Lesbians’ Health-Related Experiences of Care and Noncare.” Western
Journal of Nursing Research. 16.6 (1994): 639-659; White, Jocelyn, and Valerie Dull. Journal of
Women’s Health. 6.1 (2009): 103-112.
158 Grant, J., et al. (Forthcoming.) Report on the National Transgender Discrimination Study.
National Gay and Lesbian Task Force Policy Institute and National Center for Transgender
Equality.
OUTING AGE 2010
disrespect or discrimination from health care providers, and 11% had a care
provider refuse to treat them because they are transgender.159
Studies also have shown that LGBT people have low levels of self-disclosure
of sexual orientation in healthcare settings.160 Gay and bisexual men, and
particularly men who have sex with men but do not identify as gay, are likewise
unlikely to disclose their sexual behavior or partners to their doctors.161 Although
the findings in these studies largely are not broken out by age, it is unlikely that
the rate of self-disclosure is higher among LGBT people in midlife or old age—
and it may well be lower.
When lesbian, gay and bisexual people do not disclose their sexual identity and
behavior to health professionals, the outcome is likely to be poorer quality care.
At the same time, those choices may reflect rational decision-making. Studies
of clinician behavior have found several problematic assumptions about lesbian,
gay and bisexual people are prevalent among healthcare providers, including
a presumption that all clients are heterosexual, assumptions about clients’
sexual identities based on reported behaviors, and an assumption that all clients
are part of heteronormative families. Studies have also found that verbal and
nonverbal messages conveying the LGBT-friendliness of staff affect the quality
of healthcare delivery for LGBT people.162
These challenges may create multiple negative outcomes in clinical settings.
For instance, primary care physicians will fail to properly address these elders’
needs if the physician assumes the elders can rely on spouses, children or other
159 Transgender Law Center. (2009). State of Transgender California, March 2009. Retrieved
October 14, 2009, from www.transgenderlawcenter.org/stateoftranscafinal.pdf.
160 Bakker, F., et al. “Do Homosexual Persons Use Health Care Services More Frequently than
Heterosexual Persons: Findings from a Dutch Population Survey.” Social Science & Medicine.
63.8 (2006): 2022-2030; Klitzman, Robert, and Jason Greenberg. “Patterns of Communication
Between Gay and Lesbian Patients and their Health Care Providers.” Journal of Homosexuality.
42.4 (2002): 65-75.
161 Berstein, Kyle, et al. “Same-Sex Attraction Disclosure to Health Care Providers among New
York City Men Who Have Sex with Men.” Archives of Internal Medicine. 168.13 (2008): 14581464. Also available at: http://www.sfcityclinic.org/providers/samesexattraction.pdf.
162 Bonvicini, & Perlin. (2003). The notion that “all clients are part of heteronormative families”
refers to the assumption many providers make in the absence of a proactive disclosure of
LGBT identity by a patient or client: that all clients are heterosexual and living in traditional
nuclear family structures unless they inform the provider otherwise. Such an assumption
potentially erases the reality and health needs of LGBT elder patients and clients, who may
decide against disclosure based on an assessment of a provider’s cultural competency and
expertise in dealing with LGBT clients.
71
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relatives for informal care; for the same reason, physicians could likewise fail
to help these elders marshal the resources of chosen family and friends who
may in fact be available as caregivers. Similarly, LGBT elders who are sexually
active will not receive adequate healthcare if medical professionals act on the
widespread presumption that all elders are heterosexual as a matter of identity
and asexual as a matter of practice.
How LGBT people obtain care—and particularly how empowered they feel in
healthcare settings—is influenced by many factors. Although literature on rural
LGBT people is limited, existing studies suggest that the lack of LGBT social
networks and of LGBT-specific care limit access for LGBT residents of rural
areas.163 People of color use health services less frequently than their white
peers.164 The double/ triple jeopardy of racism, homophobia and/or transphobia
has been shown to create more significant barriers to care for LGBT people of
color. And because poor people, if they can obtain health care at all, are even
more limited in their choice of providers, they may be particularly exposed to
substandard care and poor outcomes. For LGBT people ages 65-plus, a lifetime
of having faced such limitations may be reflected in their overall health status
and in their current approach to health services.
In addition, gender variant people face specific barriers to healthcare access.
Because most transgender and gender nonconforming individuals are visibly
gender variant when they use health services, they do not have the luxury of
making choices about coming out to specific providers based on transgenderaffirming attitudes, behaviors or other cues, such as intake forms that provide
appropriate options for indicating gender or sexual orientation. Very little is
known about gender nonconformity and healthcare utilization, but one study
examining healthcare access among transgender people in San Francisco found
high levels of emergency department visits (25% of MTFs and 18% of FTMs).
Frequently obtaining care in this way often is associated with low levels of
adequate routine and preventive care.165
163 Willging, Salvador, & Kano. (2006). “Pragmatic Help Seeking: How Sexual and Gender Minority
Groups Access Mental Health Care in a Rural State.” Psychiatric Services 57.6 (2006): 871-874.
164 Agency for Healthcare Research and Quality. (2005). National Health Care Disparities Report.
Retrieved September 21, 2009, from www.ahrq.gov/qual/Nhdr05/nhdr05.htm.
165 Clements-Nolle, Marx, Guzman, & Katz. (2001). “HIV Prevalence, Risk Behaviors, Health
Care Use, and Mental Health Status of Transgender Persons: Implications for Public Health
Intervention.” American Journal of Public Health. 91.6 (2001): 915-921.
OUTING AGE 2010
While it is clear that multiple factors combine to make
healthcare access difficult for LGBT people across the
lifespan, little or no research specifically examines how these
factors affect LGBT people throughout their later years. One
national survey does, however, show that fewer than half of
LGBT people in midlife believe they will receive respectful care
in old age; this finding highlights the importance of further
study.166 Significant research is needed not only on the basic
patterns of healthcare access and use among LGBT elders,
but also on how these patterns are affected by interactions
between sexual orientation and gender presentation, race,
poverty and geography. Such studies would provide the
basis for the policy reforms and structural changes needed to
ensure healthcare access for all LGBT older adults.
73
About 29% of
people with
HIV/AIDS in the
United States
are currently
ages 50-plus but
70% of people
with HIV in the
U.S. are over 40.
HIV/AIDS
The development of highly active anti-retroviral therapy
(HAART) in the past 15 years has extended the life expectancy
of HIV-positive individuals, making it possible for those with
long-term infections to reach midlife and old age. About 29%
of people with HIV/AIDS in the United States are currently
ages 50-plus but 70% of people with HIV in the U.S. are over
40, suggesting that aging with the disease will be a significant
issue in years to come.167 A study of New York City by the
AIDS Community Research Initiative of America (ACRIA)
drives home the point: “Within the next decade, it is probable
that the majority of people with HIV in New York City will be
over age 50. This pattern is seen throughout the U.S. Yet few
have internalized this fact: There will soon be large numbers
of [elders] living with HIV and AIDS.”168
166 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006). Out and Aging: The Metlife Study of Lesbian
and Gay Baby Boomers. Retrieved September 16, 2009, from www.asaging.org/networks/
LGAIN/OutandAging.pdf, p.5.
167 US Centers for Disease Control and Prevention. (2008). “Cases of HIV infection and AIDS in
the United States and Dependent Areas, 2007.” Retrieved September 21, 2009, from www.cdc.
gov/hiv/topics/surveillance/resources/reports/2007report/pdf/2007SurveillanceReport.pdf.
168 Karpiak, S., Shippy, R., & Cantor, M. (2006). Research on Older Adults with HIV. New York:
AIDS Community Research Initiative of America, p.1.
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Older adults with HIV are part of a total population of about 1.1 million people
in the United States who were living with HIV at the end of 2006. About threequarters of those infected are men. Blacks and Latinos, along with gay and
bisexual men, are most likely to be infected.169 Black and Latino men who have
sex with men (MSM) are particularly hard-hit by the epidemic.170 The CDC
estimates that about half of the infections were transmitted during sex between
men.171 HIV/AIDS also affects lesbian and bisexual women, who are often
overlooked as a population at risk.
The CDC’s HIV/AIDS data and transmission categories are imperfect—for
example, transgender women are categorized as MSM—but the estimates
at least provide some context for recognizing the magnitude of HIV/AIDS
in the LGBT community. With regard to the transgender population, we can
supplement the CDC’s deeply inadequate statistics with data from a metaanalysis of research on HIV/AIDS prevalence among transgender people: The
study found that over one-quarter of MTFs tested positive for HIV/AIDS, with
higher rates among African-American transgender women; the rates among
FTMs were found to be very low.172
When reviewing HIV statistics, it’s vital to note that the infection rate in
older adults is likely to be severely underreported. In 2006, the CDC’s
recommendations for HIV testing reflect this lack of attention to older adults,
by recommending routine testing only up to age 64.173 A recent report from
ACRIA notes, “Since physicians do not perceive older adults to be at risk for
HIV infection, they are less likely to test them for the virus. Consequently, underdiagnosis occurs, and HIV is detected later.”174 Failing to test older patients
not only does a grave disservice to elders with HIV by depriving them of timely
treatment, but also puts at risk others who may have sexual contact with them.
169 US Centers for Disease Control and Prevention. (2008).
170 MSM (men who have sex with men), is a term used by some to refer to male-assigned-atbirth persons who have sex with men regardless of sexual orientation or gender identity. WSW
(women who have sex with women) is the equivalent term for women sexually active with other
women, who do not necessarily identify as lesbian or bisexual.
171 US Centers for Disease Control and Prevention. (2008).
172 Herbst, Jeffrey, et al. “Estimating HIV Prevalence and the Risk Behaviors of Transgender
Persons in the United States.” AIDS and Behavior. 12.1 (2008): 1-17.
173 US Centers for Disease Control and Prevention. (2006). “Revised Recommendations for HIV
Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings.” Retrieved
October 14, 2009, from: www.cdc.gov/hiv/topics/over50/cdc.htm.
174 Karpiak, S., Shippy, R., & Cantor, M. (2006), p.2.
OUTING AGE 2010
Combined with poor clinical practices born of homophobia and transphobia, the
desexualization of elders thus can have a ripple effect, first potentially harming
the individual elder, and then spiraling outward.
Older adults with HIV/AIDS face the prospect of dealing with both the routine
challenges of aging and the specific medical and psychosocial issues presented
by their distinctive health status. For example, one study of HIV/AIDS in older
adults found that over half the participants had depression, a percentage
much higher than the rate in the general population of elders.175 In addition to
the issues faced by all elders with HIV, transgender older adults with HIV may
have additional concerns: the interacting effects of aging, HIV/AIDS, HAART
and cross-gender hormones are unknown; this is an important area for further
research.
CANCER RISK FACTORS, CANCER SCREENING AND CANCER RATES
Cancer is the second most prevalent cause of death for older people in the
United States.176 Lesbian, gay and bisexual people in general have an increased
risk for cancer relative to their heterosexual counterparts.177 Numerous studies
have documented higher rates of smoking among lesbian, gay and bisexual
populations, and others have documented greater use of alcohol and other
drugs. Obesity, a condition associated with increased cancer risk, may be more
prevalent among lesbians, bisexual women and women who have sex with
women.178 In addition, aging itself increases the risk for many forms of cancer.
All these factors make cancer a particular concern for lesbian, gay and bisexual
older adults.
Furthermore, a large number of gay and bisexual men and MSMs are living with
HIV and AIDS, as are many transgender people and some lesbian and bisexual
women. HIV and AIDS increase risks for cancer, because specific cancers
are linked to the infection and because HIV weakens the immune system and
cancers grow more quickly in people with the virus. Thanks to improved anti-
175 Karpiak, S., Shippy, R., & Cantor, M. (2006); this study found depression to be the highest comorbidity for people with HIV.
176 US Centers for Disease Control and Prevention. (2008).
177 Mayer, et al. (2008). “Sexual and Gender Minority Health: What We Know and What Needs
to Be Done.” American Journal of Public Health. 98.6 (2008): 989-995.; Harrison, AE, and
VM Silenzio. “Comprehensive Care of Lesbian and Gay Patients and Families.” Primary Care
Clinics in Office Practice. 23.1 (1996): 31-46.
178 Mayer, et al. (2008).
75
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retroviral therapies, people with HIV and AIDS are living longer. For older adults
with HIV, this longevity means increased rates of HIV/AIDS-related cancers as
well as cancers related to aging. Kaposi’s sarcoma, non-Hodgkin’s lymphoma
and human papilloma virus (which increase the risk of cervical cancer in women
and anal cancer in men) are all related to HIV/AIDS.179
In the transgender population, very little is known about longevity, disease, and
specific aging-related cancer risks. One large Dutch study found no evidence of
increased mortality from cancer or other causes among either male-to-female
or female-to-male transgender people undergoing cross-gender hormone
therapy.180 Nonetheless, some clinicians remain concerned about high rates of
polycystic ovarian disease among transgender men.181 Because transgender
women have a high rate of HIV infection, they are also more vulnerable to HIVrelated cancers.
Researchers have not looked specifically at cancer screening rates among
LGBT elders, an issue which would merit investigation. For lesbian and bisexual
women in general, numerous studies have documented rates of Pap smear and
mammogram screenings lower than those for women in general.182 Gay men’s
use of cancer screening has not been similarly investigated; however, some
researchers have suggested that their generally low levels of knowledge about
anal cancer may be contributing to disease burden.183
179 Dezube, B. J., Von Roenn, J. H., Holden-Wiltse, J., Cheung, T. W., Remick, S. C., Cooley,
T. P., Moore, J., Sommadossi, J. P., Shriver, S. L., Suckow, C. W., & Gill, P. S., et al. (1998).
“Fumagillin Analog in the Treatment of Kaposi’s Sarcoma: A Phase I AIDS Clinical Trial Group
Study. AIDS Clinical Trial Group No. 215 Team.” Journal of Clinical Oncology. 16.4 (1998): 14441449.
180 Van Kesteren, Asscheman, Megens, Gooren. (1997). “Mortality and Morbidity in Transsexual
subjects Treated with Cross-Sex Hormones.” Clinical Endocrinology. 47.3 (2003): 337-343.
181 Moore, Wisniewski, & Dobbs. (2003). “Endocrine Treatment of Transsexual People: A Review of
Treatment Regimens, Outcomes, and Adverse Effects.” Journal of Clinical Endocrinology and
Metabolism. 88.8 (2003): 3467-3473.
182 Kerker, Bonnie, Farzad Mostashari, and Lorna Thorpe. “Health Care Access and Utilization
among Women Who Have Sex with Women: Sexual Behavior and Identity.” Journal of Urban
Health. 83.5 (2006): 970-979; Roberts, Susan, and Lena Sorensen. “Health related behaviors
and cancer screening of lesbians: Results from the Boston Lesbian Health Project.” Women
and Health. 28.4 (1999): 1-12.
183 Pitts, M., Fox, et al. (2007). “What Do Gay Men Know about HPV? Australian Gay Men’s Knowledge
and Experience of Anal Cancer Screening and HPV.” Sexually Transmitted Diseases. 34.3 (2007):
170-173.
OUTING AGE 2010
What remains unclear is whether disparities in cancer screening and cancer
risk translate into different rates of cancer among people of different sexual
orientations and gender identities. One study in Denmark found no measurable
difference between individuals in registered same-sex partnerships and those
in opposite-sex partnerships, with the exception of a higher rate of AIDSassociated Kaposi’s sarcoma among those with same-sex partners; however,
this study is limited in that it investigates partnership rather than sexual
orientation and only addresses disparities in a single country which, unlike the
United States, has universal health care. 184 The issue merits further study.
Income, immigration status and race are all important predictors of cancer
mortality in the U.S. population as a whole. For example, African-American
women are more likely to die of breast cancer than are white women, although
their incidence of the disease is lower.185 Immigration status and race both
affect utilization of cervical cancer screening, and some preliminary evidence
suggests race may interact with sexual orientation to predict lower rates of
cancer screening.186 LGBT elders in these populations groups may therefore
face double- or triple-jeopardy risk.
CHRONIC DISEASE AND OTHER SERIOUS PHYSICAL HEALTH PROBLEMS
Chronic diseases such as diabetes, cardiovascular disease and HIV are leading
causes of death in the United States—and with many of these diseases; aging is
a factor for increased risk. Although there is no direct evidence of elevated levels
of chronic disease among LGBT people, this population does experience in
various ways numerous risk factors, including higher rates of smoking, drinking,
drug use and obesity than those for the general population.187 African Americans
and Latinos also are at elevated risk for specific chronic diseases, for example,
184 Frisch, M., Smith, E., Grulich, A., & Johansen, C. (2003). “Cancer in a Population-based
Cohort of Men and Women in Registered Homosexual Partnerships.” American Journal of
Epidemiology. 157.11 (2003): 966-972.
185 Tammemagi, et al. (2007). “Comorbidity and Survival Disparities Among Black and White
Patients With Breast Cancer.” Journal of American Medical Association. 294.14 (2005): 17651772.
186 On cervical cancer screening, see Tsui, J., Saraiya, M., Thompson, T., Dey, A., Richardson, L.
(2007). “Cervical Cancer Screening among Foreign-born Women by Birthplace and Duration
in the United States.” Journal of Women’s Health. 16.10 (2007): 1447-1457; Owusu, Gertrude,
et al. “Race and Ethnic Disparities in Cervical Cancer Screening in a Safety-Net System.”
Maternal and Child Health Journal. 9.3 (2005): 285-295.
187 Mayer, et al. (2008).
77
Genevieve Trusouix Milwaukee, Wisconsin, 63
G
enevieve, or Geni, can
usually be found at the
front desk of SAGE Milwaukee’s
offices, answering the
organization’s many phone and
email inquiries.
Geni reflects fondly on her
childhood, remembering the times
that she was once called William,
the name given to her at birth. The
youngest of four children, Geni
adored her parents and the love
that they had for each other and
their children. Yet although she
knew she was loved, she feared
her parents ever finding out that
they had a “third daughter.” She
says, “I was terrified that if they
found out, for my ‘own good’ they
would institutionalize me. Back
then they did that, and to this
day, it still can happen. Barbarism
knows no bounds.”
Geni remembers that she spent
many years becoming herself—
out and comfortable at home, and
more private in the workforce.
At age 25, Geni, as William,
married Mary Angela, “the most
wonderful, extraordinary woman
in the world.” Geni simply says,
“I cannot imagine my life without
her. She has been my strength
and inspiration in all that I have
accomplished in my adult life.”
Contrary to what some may
think, Mary and Geni’s marriage
flourished, and became even
stronger with transition. “Mary
had knowledge of who I was
after four years of marriage, and
subsequently kept my secret from
everybody.”
Despite her warm and safe home
environment, Geni spent more
time as “William” in the workforce.
“After spending 33 years in the
printing trade where I had to be
butchy all the time, I went to
sales and still couldn’t be myself.
In sales I worked for the Better
Business Bureau of Wisconsin
for two-and-a-half years, and
they were incredibly homophobic
and transphobic there, like most
places, so the lovely Miss G never
came out.” Eventually, however,
after a few more stints in the
labor force, Geni enrolled in the
Interfaith Older Adult Program,
a product of the Title V program
launched by the U.S. Labor
Department, in order to help older
adults upgrade existing job skills
and become more employable,
and found a welcoming response.
“When I first enrolled in Interfaith,
I had a private word with Barb,
my manager, at which time I told
her about me. Her initial reaction
was, ‘why are you telling me this?’
which I found understandable. But
right after that, she went to bat
for me to get assigned to SAGE
Milwaukee as an administrative
assistant to the Executive
Director, Bill Serpe.”
Additionally, Geni notes how
Barbara and Bill advocated
for Geni to go to her Interfaith
monthly meetings as Geni,
instead of William. “Initially I was
going to these meetings in drag
[as William] so as not to confuse
the other members as well as the
Interfaith management, but after
an intervention from my boss and
with the help of Barb and others,
I am able to now go as myself.
There are usually 30 to 35 other
people, and I’m just another one
of the girls!”
For Genevieve, to be able to
be herself in all situations,and
in all walks of her life has been
tremendous for her, and is so
thankful to be able to “wake up
and realize that you are finally
yourself, and not have to live a lie
anymore.”
OUTING AGE 2010
diabetes and heart disease, but the intersections between racial disparities and
sexual orientation disparities are largely unknown. 188
The specific risks for chronic conditions among transgender elders have
received little or no attention from researchers. Studies involving small
convenience samples of younger subjects suggest, however, that certain chronic
diseases may be more common among people receiving cross-gender hormone
therapy. Both FTMs and MTFs who are undergoing such therapy may be at
risk for diabetes.189 The risks for hypertension among transgender people are
unknown, but transgender women using progesterone and estrogen should be
closely monitored.190 Estrogen use also may increase the risk for cardiovascular
disease among transgender women; however, data are limited.191
In addition, case reports document cerebrovascular incidents—brain problems
resulting from disease of blood vessels supplying the brain—among transgender
men.192 Some clinicians advocate hysterectomy and reduction of testosterone
treatment for transgender men after the first two years of therapy to avoid
adverse events related to masculinizing cross-gender hormones. Transgender
women may be at risk for venous thrombosis as a result of sex-steroid
therapy.193 Overall, the limited reports on chronic conditions in transgender
people raise questions that call for systematic research, including research on
possible connections between transgender aging and chronic conditions.
188 LaVeist, Thomas A., et al. “Environmental and Socio-Economic Factors as Contributors to
Racial Disparities in Diabetes Prevalence.” Journal of General Internal Medicine. 24.10 (2009):
1144-1148; Jha, A, et al. “Differences in Medical Care and Disease Outcomes among Black
and White Women with Heart Disease.” Circulation. 108.9 (2003): 1089-1094.
189 Dahl, Marshall, et al. “Physical Aspects of Endocrine Therapy.” Guidelines for Transgender Care.
Eds. Walter Bockting and Joshua Goldberg. Binghamton: Haworth Medical Press, 2006. 111-134.
190 Feldman & Goldberg. (2006).
191 Feldman & Goldberg. (2006); Van Kesteren, Asscheman, Megens, and Gooren. Clinical
Endocrinology. 47.3 (2003): 337-343.
192 Moore, Wisniewski, and Dobbs. “Endocrine Treatment of Transsexual People: A Review of
Treatment Regimens, Outcomes, and Adverse Effects.” Journal of Clinical Endocrinology and
Metabolism. 88.8 (2003): 3467-3473.
193 Moore, Wisniewski, & Dobbs. (2003).
79
80
HEALTH
MENTAL HEALTH
Mental health problems affect up to 20% of Americans in a given year.194 By
contrast, the reported rates of mental health issues among older adults are lower
than those of other adult age groups.195 The many older adults who nonetheless
require mental health services find that barriers to care still exist—with particular
barriers to care for LGBT elders, most of whom lack access both to agesensitive and to LGBT-sensitive providers.
In the past, insurance companies in the United States did not cover mental
health problems as comprehensively as physical health problems, but this
disparity will be reduced in coming years: The Medicare Improvements for
Patients and Providers Act of 2008 “provides parity in coverage for mental
health care by gradually lowering copayments for services over a six-year
period until they match other healthcare copayment rates. The bill also expands
psychiatric drug benefits and includes a provision to expand access to mental
health care in rural America by making community mental health centers eligible
to participate in the Medicare telehealth program.”196 The law goes into effect in
2010.
LGBT elders may struggle with mental health problems as a result of enduring
many years of discrimination, violence and enforced social invisibility and
isolation.197 Until 1973, the American Psychiatric Association classified
homosexuality as a mental illness; many older lesbian, gay and bisexual people
thus experienced the mental health system when their sexual orientation was
defined as pathological. As of this writing, transgender people are still forced
to accept a mental-disorder classification—gender identity disorder—as the
194 US Department of Health and Human Services. (1999). “Mental Health: A Report of the
Surgeon General—Executive Summary.” Rockville, MD: US Department of Health and Human
Services, National Institute of Mental Health. Retrieved from www.surgeongeneral.gov/library/
mentalheatlh/chapter2/sec2_1.html
195 US Center for Disease Control, National Center for Health Statistics. (2008). “National
Comorbidity Study.” (2008). Retrieved from www.hcp.med.harvard.edu/ncs/ftpdir/table_
ncsr_12monthprevgenderxage.pdf.
196 Bane, Share DeCroix. “Resilience and Advocacy: Keys to Survival For Elders, Professionals,
Organizations.” Dimensions: Newsletter of Mental Health and Aging Network. American Society
on Aging. Winter 2008-Spring 2009. Web. Accessed 5 January 2010. Available at: http://www.
asaging.org/asav2/mhan/enews/08win-09spr/network_news.cfm.
197 Appelbaum, P. S., Candilis, P. J., Fletcher, K. E., Geppert, C., & Lidz, C. W. (2008). “A Direct
Comparison of Research Decision-Making Capacity: Schizophrenia/Schizoaffective, Medically
Ill, and Non-ill Subjects.” Schizophrenia Research. 99.1 (2008): 350-358.
OUTING AGE 2010
asis for obtaining appropriate hormonal and surgical transition services.198
Accordingly, many LGBT elders may see the mental health system as inherently
untrustworthy and may therefore choose not to seek needed care.
Quantitative studies specifically focused on the mental health concerns of LGBT
elders are largely lacking, but numerous studies have documented elevated
rates of mental distress and mental illness among LGBT people across the
life course.199 For example, in a review of five large studies, gay and bisexual
men were twice as likely as individuals in the general population to have had
a mental disorder, and lesbian women were more than three times as likely.200
Suicide attempts, depression, anxiety and substance abuse are all elevated
among LGBT people.201 Many authors posit that the stress LGBT people face
due to prejudice and legal discrimination may be a cause of negative mental
health outcomes.202 One study found that when poor social support and poor
198 Ruble, M. W., & Forstein, M. (2008). “Mental Health: Epidemiology, Assessment, and
Treatment.” Makadon, H. J., Mayer, K. H., Potter, J., & Goldhammer, H. (eds.) The Fenway
Guide to Lesbian, Gay, Bisexual, and Transgender Health. American College of Physicians.
199 Mayer, et al. (2008). “Sexual and Gender Minority Health: What We Know and What Needs to
be Done.” American Journal of Public Health. 98.6 (2008): 989-995.
200 Mayer, Ilan. “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual
Populations: Conceptual Issues and Research Evidence.” Psychology Bulletin. 129.5 (2003):
674-697.
201 Balsam, K. F., Beauchaine, T. P., Mickey, R. M., & Rothblum, E. D. (2005). “Mental Health of
Lesbian, Gay, and Bisexual Adults and their Heterosexual Siblings: Effects of Gender, Sexual
Orientation, and Family.” Journal of Abnormal Psychology. 114.3 (2005): 471-476.
202 Many articles have speculated that being targets of racism, sexism, transphobia and
homophobia may result in higher rates of psychological problems because of stress such
as Meyer. (2003). This issue, however, has not been rigorously investigated and findings are
mixed, making the 2009 grant by the State of California to Equality California to study mental
health issues among LGBT youth and elders especially significant. Four studies of Latino
and Asian LGB-identified and same-sex experienced individuals found elevated levels of
psychological problems, including suicide attempts for men and depressive disorders for
women in Cochran, et al. (2007). “Mental Health and Substance use Disorders among Latino
and Asian American Lesbian, Gay, and Bisexual Adults.” Journal of Consulting and Clinical
Psychology 75(5); psychological stress in Siegel, & Epstein. (1996). “Ethnic-racial Differences
in Psychological Stress Related to Gay Lifestyle among HIV-positive Men.” Psychological
Reports. 79(1); Yoshikawa, H., & Wilson, P. A. (2004). “Experiences of and Responses to Social
Discrimination among Asian and Pacific Islander Gay Men: Their Relationship to HIV Risk.”
AIDS Education Prevention 16(1) found a relationship between discrimination and experiences
of psychological distress among gay and bisexual men of color. However, other studies have
found only inconsistent evidence of elevated psychological problems among people of color
who identify as LGBT compared to those who are not. See review in Cochran, et al. (2007).
81
82
HEALTH
coping skills were controlled for, sexual orientation differences in mental health
outcomes disappeared.203
Mental health needs of transgender people, including transgender elders, may
involve both transgender-specific and more general concerns. Investigations
find elevated rates of depression, suicidal thoughts, and suicide attempts
in the transgender population.204 Because mental health providers often are
gatekeepers for cross-gender hormone therapy or sex reassignment, many
transgender people may mistrust the mental health system and not seek out
needed care for mental health concerns. Life-course studies are needed to
understand the mental health of aging transgender people, whether or not they
continue cross-gender hormone therapy into old age.
Another mental health issue where LGBT disparities are documented is
substance abuse. Much of this research has focused on younger people; the
effects for elders have not been well studied. From the existing research, it is
nonetheless clear that substance abuse is a concern for the LGBT community
overall. Smoking, which can lead to lung cancer and other health problems, is
elevated among LGBT people.205 Alcohol abuse is more common among lesbian
and bisexual women than among heterosexual women, and some studies
One study of American Indians found higher levels of mental health-related symptoms among
Two Spirit people than those who were not. See Balsam, K. F., Beauchaine, T. P., Mickey, R.
M., & Rothblum, E. D. (2005). “Mental Health of Lesbian, Gay, and Bisexual Adults and their
Heterosexual Siblings: Effects of Gender, Sexual Orientation, and Family.” Journal of Abnormal
Psychology 114(3). The one study to examine interactions between age and race in LGBT
populations looked only at gay men and found that older Black gay men reported more ageism,
racism and homo-negativity than younger Black gay men or White older gay men. See David,
& Knight. (2008). “Stress and coping among gay men: age and ethnic differences.” Psychology
and Aging 23(1). Nonetheless, these subjects did not, as a result, have worse mental health
outcomes.
203 Safren & Heimberg. (1999). “Depression, Hopelessness, Suicidality, and Related Factors in
Sexual Minority and Heterosexual Adolescents.” Journal of Consulting and Clinical Psychology.
67.6 (1999): 859-866.
204 Clements-Nolle, Marx, Guzman, & Katz. (2001). “HIV Prevalence, Risk Behaviors, Health
Care Use, and Mental Health Status of Transgender Persons: Implications for Public Health
Intervention.” American Journal of Public Health. 91.6 (2001): 915-921; Grossman, H., Anthony,
D., Dragowski, E. (2007). “Caregiving and Care Receiving Among Older Lesbian, Gay, and
Bisexual Adults.” Journal of Lesbian and Gay Social Services 18(3-4). Findings on other mental
health issues are mixed, and more research using large, diverse samples is needed. See
Feldman, & Goldberg. (2006).
205 Gruskin, et al. (2007). “Disparities in Smoking Between the Lesbian, Gay, and Bisexual
Population and the General Population in California.” American Journal of Public Health 97(8):
1496-1502. Tang, H., Greenwood, G., Cowling, D. W., Lloyd, J. C., Roeseler, A. G., & Bal, D. G.
OUTING AGE 2010
also find that the rate is higher among gay men than among
heterosexual men.206 Finally, illegal drug use and dependence are
more common among LGBT people than non-LGBT people.207
Patterns of substance abuse within the LGBT community reflect
considerable diversity. One study found that young butch women
were more likely than young femme women to smoke, drink and
use marijuana.208 Substance abuse among Black men who have
sex with men is generally found to be equal to or lower than
the substance use among other MSMs, despite a widespread
misperception that Black MSMs abuse drugs at higher rates.209
Almost no research has been conducted specifically on aging
and substance abuse among LGBT people, but given the impact
of current or lifelong substance abuse on mental and physical
well-being, such research would be invaluable.
83
Providers of
mental health
care would do
well to recognize
and build on
the distinctive
psychological
strengths LGBT
older adults
possess.
To provide proper care for LGBT older adults, mental health
professionals must address the disparities faced by these
elders. At the same time, providers of mental health care would
do well to recognize and build on the distinctive psychological
strengths LGBT older adults possess. The MetLife report on
LGBT boomers, for instance, found that “nearly four out of 10
respondents to the current survey (38%) said that they have
developed positive character traits, greater resilience or better
support networks as a consequence of being lesbian, gay,
(2004). “Cigarette Smoking among Lesbians, Gays, and Bisexuals: How Serious a Problem?”
Cancer Causes and Control 15(8): 797-803.
206 On women, see Wilsnack, et al. (2008). “Drinking and Drinking-Related Problems Among
Heterosexual and Sexual Minority Women.” Retrieved September 16, 2009, from vnweb.
hwwilsonweb.com/hww/jumpstart.jhtml?recid=0bc05f7a67b1790e84b1b59914601da46d1
3d822b54fb9a3fedf01f2e6c6b55daecc97063eb90091&fmt=P. On men, see Marshal, M. P.,
Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). “Sexual Orientation
and Adolescent Substance Use: A Meta-Analysis and Methodological Review.” Addiction.
103.4 (2008): 546-556.
207 Clements-Noelle, et al. (2001); Cochran, et al. (2004); Marshal, et al. (2008).
208 Rosario, Schrimshaw, & Hunter. (2008). “Substance Use and Abuse among Lesbian, Gay, and
Bisexual Youths: The Role of Rejection to Disclosure.” STASH 5(5).
209 Nanin, J. E., Parsons, J. T., Bimbi, D. S., & Grov, C. (2006, November). Harm Reduction in High
Heels: The DIVAs (Drag Initiative to Vanquish AIDS). Conference presentation; Jerome, R., &
Halkitis, P., & Coley, M. (2009). Methamphetamine Use Patterns among Urban Black Men who
have Sex with Men. Culture, Health, & Sexuality. 11.4 (2009): 399-413.
84
HEALTH
bisexual or transgender. Notably, Hispanic respondents (51%)
and African American respondents (43%) were considerably
more likely than the sample as a whole to agree that their
LGBT identities had helped them as they approached midlife
and old age.”210 Other studies similarly have found that
learning to cope with social marginalization throughout their
lives gives many lesbian and gay people a degree of resilience
which also helps them adapt to aging.211
PUBLIC HEALTH PROGRAMS AND OUTREACH
In recent years, some nonprofits and health departments in the
United States have started addressing LGBT health disparities
and risk factors through research and targeted public health
campaigns. Such approaches are crucial to the survival and
well-being of LGBT older adults. Diverse images of elders
such as those employed by SAGE in New York City should be
used in campaigns of this sort.212 Furthermore, where there are
significant disparities in healthcare utilization by LGBT people,
persuasive, well-researched public health campaigns should
address the causes and consequences for our elders.
In addition, public health messages about HIV prevention
and treatment should not be targeted only toward either
LGBT young people or heterosexual elders, as has all too
often been the case. Because LGBT people in midlife and
old age likewise are at risk for HIV, appropriate interventions
must be designed to meet their needs. An example of such a
campaign is HIV Stops With Us (formerly HIV Stops With Me),
used for the past several years in Boston, Buffalo, Oakland,
and other cities. This campaign includes images of people in
midlife and old age as part of an intergenerational mix.213
210 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006). Out and Aging: The Metlife Study of Lesbian
and Gay Baby Boomers. Retrieved September 16, 2009, from www.asaging.org/networks/
LGAIN/OutandAging.pdf, p.14.
211 For an overview of this literature, see Boyer, C. (2007).
212 For more on the “SAGE Is…” campaign, visit www.sageusa.org/specialevents/home.cfm?ID=28.
213 For details on this campaign, visit www.hivstopswithus.org. Other notable efforts in this arena:
The AIDS Community Research Initiative of America (ACRIA) provides LGBT-inclusive trainings
on HIV infection in older adults that includes information on healthy sexual activity. Gay Men’s
OUTING AGE 2010
POLICY RECOMMENDATIONS
To advance the physical and mental health of LGBT elders, The Task Force calls
on legislators, public agencies, providers of health and mental health services,
and community advocates to take the following steps:
•
Pass legislation at the state and national levels that ensures access to
affordable health insurance for people of all ages and that guarantees
coverage for gender-related services.
•
Collect LGBT-specific data in all federal studies and surveys on physical
and mental health. This data must include age demographics so that LGBT
health challenges and disparities can be tracked over the lifespan.
•
Develop and institute health promotion and healthcare-access policies and
programs specifically designed to bring needed care to LGBT people in
midlife and old age.
•
Conduct specific research on the physical and mental health consequences
of racism, economic injustice, homophobia, and transphobia as experienced
by LGBT elders over the lifespan.
•
Train healthcare professionals to recognize and respond to the specific
health risks, vulnerabilities, resiliencies, and needs of LGBT older adults.
•
Train public and private healthcare providers in cultural competence for
working with LGBT older adults, including how to address LGBT patients
in an appropriate manner and how to create a welcoming environment.
Tie funding, accreditation and degree requirements to LGBT cultural
competency certification.
•
Develop, fund and carry out health promotion and treatment information
campaigns targeted to reduce health disparities in LGBT older adults.
•
Support a National AIDS Strategy that would include the establishment of
prevention, testing and treatment guidelines and programs designed to
specifically address the issue of HIV/AIDS among LGBT people ages 50-plus.
•
Press the Centers for Medicare and Medicaid Services (CMS) to revise their
National Coverage Determination to ensure medically-necessary treatments
Health Crisis (GMHC) in New York has conducted an HIV-prevention social marketing campaign
known as the “ElderSexual” campaign.
85
86
CAREGIVING, SOCIAL ISOLATION, AND HOUSING
related to gender transition and to remove barriers to health care related to
an individual’s pre-transition gender.
CAREGIVING, SOCIAL ISOLATION, AND HOUSING
Receiving respectful care, maintaining social connections and finding
appropriate housing are three of the most important keys to well-being for all
older adults. Studies show that the majority of Americans hope to age in place
in the homes and communities where they have always lived; informal care and
formal supportive services help elders maintain this cherished independence
as long as possible.214 At the same time, many older adults prefer or require
specialized housing, ranging from independent living communities to assisted
living or skilled nursing facilities. For LGBT older adults, these issues take on
added weight, as these elders face distinctive challenges in confronting isolation
and identifying options for culturally competent care and housing.
CAREGIVING
Since the last edition of Outing Age, a significant advancement has been
achieved in the realm of caregiving for LGBT Elders: The federal Family
Caregivers Support Program, created with the 2000 reauthorization of the Older
Americans Act and amended in 2006, has expanded its definition of family
caregivers so that extended LGBT family members qualify. Eligibility for the
program is not limited to a married partner or blood relative. As a consequence,
LGBT people caring for partners or other members of their chosen families
can use services provided under the program, including individual counseling,
support groups, caregiver training, respite care, and other supplemental
assistance.
In the U.S., approximately 80% of long-term care is provided by informal
caregivers.215 More than two-thirds (78%) of adults living in the community who
need care depend on such caregivers as their only source of help.216 Yet older
LGBT people are frequently disconnected from their families of origin and—
according to a national needs assessment conducted by SAGE in 2003—are
214 For example, see Flory, J., Young-Xu, Y., Gurol, I., & Levinsky, N. (2004). Place of Death: U.S.
Trends Since 1980. Health Affairs 2(3), pp.194-200.
215 Coleman, B., & Pandya, S.M. (2002). Family Caregiving and Long-Term Care. AARP Public
Policy Institute. Retrieved from assets.aarp.org/rgcenter/il/fs91_ltc.pdf.
216 Family Caregiver Alliance. (2001). Fact Sheet: Selected Caregiver Statistics. Retrieved from
www.caregiver.org/caregiver/jsp/print_friendly.jsp?nodeid=439.
OUTING AGE 2010
four times less likely to have children and grandchildren than
are non-LGBT older adults.217 They are also twice as likely to
live alone. Since the primary caregivers for most elders are
spouses and children, these realities place older LGBT people
at high risk of finding themselves without care when they need
it.
As our community did in the early days of the AIDS crisis,
LGBT people are trying to fill this caregiving gap by
developing new communities and configurations of support.
For instance, one recent study found that gay and lesbian
elders “received significantly more support from friends, while
heterosexual elderly derived more support from biological
family members.”218 Similarly, a national survey of LGBT baby
boomers by the MetLife Mature Market Institute found that
42% of LGBT caregivers reported assisting partners, friends,
neighbors, or others outside of their families of origin. Another
recent study found 32% of gay men and lesbians providing
some sort of informal caregiving; 61% of their care recipients
were friends and 13% were partners.219
87
Gay and
bisexual men
are about as
likely as lesbians
and bisexual
women to report
caregiving for
other adults.
LGBT caregiving departs from the heterosexual model in
other ways, as well. For instance, the MetLife study found
that lesbian and gay boomers are more likely than their
non-LGBT peers to provide care: one in four lesbian or gay
boomers is a caregiver, compared to one in five non-LGBT
boomers.220 Likewise, the MetLife study shows that the
trend of men taking on a greater share of caregiving—a task
that traditionally fell overwhelmingly to women—was more
advanced in the LGBT community: The survey found that gay
and bisexual men are about as likely as lesbians and bisexual
women to report caregiving for other adults, whereas the most
217 Cook-Daniels, L. (2004).
218 Grossman, H., Anthony, D., & Dragowski, E. (2007). “Caregiving and Care Receiving Among Older
Lesbian, Gay, and Bisexual Adults.” Journal of Lesbian and Gay Social Services 18(3-4), p.17.
219 Fredriksen-Goldsen, K. (2007). Caregiving With Pride. Philadelphia: Haworth Press.
220 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006).
88
CAREGIVING, SOCIAL ISOLATION, AND HOUSING
comprehensive study of the general population found that only 39% of
caregivers are male.221
Research reveals a number of other distinctive trends in caregiving and care
receiving among LGBT people:
•
Those who have given care to LGBT elders in the past are more likely to give
care again in the future.222
•
Even though at least three-quarters of LGBT boomers expect to become
caregivers for someone else, almost one in five reported being unsure who
will take care of them when the need arises.223
•
With increases in age comes an increase in caring for one’s LGBT partner,
as “those 50 or older also reported taking care of a partner more often
than younger respondents (21% vs. 15%). Notably, an additional 4% of all
caregivers are assisting their partner’s parent or sibling.”224
Trends in caregiving and care receiving among transgender Americans are less
known than are those of the non-transgender population. Researchers have
argued that like non-transgender gay men and lesbians, transgender elders
may not have support from their biological families and thus may “turn to public
and fee-for-service assistance when they face debilitating effects of serious
illness or functional impairment.”225 The Task Force/NCTE National Transgender
Discrimination Survey found that 40% of its sample of 6,500 transgender and
gender non-conforming respondents suffered from parental rejection and
30% from rejection by their children.226 Substantial quantitative and qualitative
221 National Alliance for Caregiving and AARP. (2004). Caregiving in the U.S. Bethesda, MD:
National Alliance for Caregiving. Retrieved September 16, 2009, from www.caregiving.org/
data/04finalreport.pdf
222 Grossman, H., Anthony, D., & Dragowski, E. (2007). “Caregiving and Care Receiving Among
Older Lesbian, Gay, and Bisexual Adults.” Journal of Lesbian and Gay Social Services 18(3-4).
223 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006).
224 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006).
225 See, for example, Williams, M., & Freeman, P. (2007). “Transgender Health: Implications for
Aging and Caregiving.” Journal of Gay and Lesbian Social Services 18(3-4).
226 Grant, J., et al. (Forthcoming). Report on National Transgender Discrimination Survey. National
Gay and Lesbian Task Force & National Center for Transgender Equality.
OUTING AGE 2010
research on the caregiving needs and experiences of transgender elders remains
to be done.
Many LGBT people serve as caregivers not only in their families of choice
but also in their families of origin, yet despite carrying more of the load, they
receive less support from policies and programs designed to help caregivers.
For example, the federal Family and Medical Leave Act gives many caregivers
job flexibility, leave, and job security —but only if they are related to the care
recipient by blood or marriage. This means that if LGBT caregivers are caring for
a partner, a partner’s parent or sibling, or a friend, they do not receive assistance
and protection.
Compounding this lack of federal benefits, few of the emerging caregiver
support programs in the United States are tailored to meet the needs of
LGBT caregivers. A notable exception at the national level is the online LGBT
caregiving discussion group offered by the Family Caregiver Alliance, an
advocacy and services nonprofit based in San Francisco.227 Similarly, SAGE
has developed a model initiative to support LGBT caregivers for elders in New
York City; it remains however, the only LGBT caregiving program in the U.S.
funded with federal dollars. A scattering of efforts also have been established
elsewhere, such as the LGBT caregiver support groups hosted by the Caregiver
Alliance of Suffolk County in Jamaica Plain, Mass.; Area Agency on Aging
Region One in Phoenix; and Leeza’s Place at Olympia Medical Center in Los
Angeles.
SOCIAL ISOLATION
Given recent initiatives to fund programs to support aging in place, it is
becoming more common for elders to continue living in their own homes even
as they require increasing levels of support. But for LGBT elders aging in place,
a high level of independence along with lower rates of assistance from partners
and biological children may create a precarious balance between living alone
and living in social isolation. For example, one study using population-based
data from New York City found that 8,000 lesbian, gay and bisexual seniors were
in danger of social isolation.228 If “family members and close friends—usually
227 For details or to join the discussion group, visit www.caregiver.org/caregiver/jsp/content_node.
jsp?nodeid=490.
228 Frazer, M. S. (2009). LGBT Health and Human Service Needs in New York State. Empire State
Pride Agenda: Albany, NY. www.prideagenda.org/Portals/0/pdfs/LGBT%20Health%20and%20
Human%20Services%20Needs%20in%20New%20York%20State.pdf.
89
Nancy K. Bereano Ithaca, New York, 66
N
ancy Bereano is a born
innovator. Born in the Bronx,
Nancy moved to Ithaca, New York
in her 20s and never looked back.
Always an activist, Nancy realized
the power of small presses to
bring new and innovative voices
to the public. After working with
The Crossing Press on their
Feminist Series, Bereano went
on to create her own press in
1985 called Firebrand Books.
She felt it imperative to create a
venue for publishing voices from
the lesbian feminist movement,
who “changed ways of thinking…
the ways in which ideas were
discussed, challenged.” The
lesbian community, at least in the
1980s, organized and informed
itself through books and literature,
so there was an opportunity to
distribute ideas on a much larger
scale.” Firebrand Books became
wildly successful, publishing
works by Dorothy Allison, Alison
Bechdel, Leslie Feinberg, Audre
Lorde, and Cherríe Moraga during
its fifteen year tenure.
After she sold Firebrand, Nancy
volunteered at local hospices,
recording patients’ oral histories
for their families. During this time,
she co-founded the Tompkins
County Working Group on
LGBT Aging, a collection of
twelve “grassroots activists and
gerontological professionals,
including the Executive Director
of the Tompkins Country Office
for the Aging and the Executive
Director of Lifelong, the local
senior center, who explore a
variety of options to positively
affect the cultural competency of
the care given to LGBT seniors.”
One of the Working Group’s
newest projects has been to
develop a “Share the Care”
program for LGBT older adults.
“The idea for ‘Share the Care’
in the LGBT community arose
from my experience of being one
of the caregivers for a friends
during the last year of her life
after a long struggle with cancer.
If Candice had been 73 instead
of the 63 that she was, there
wouldn’t have been many of us
to help her, because we would
have been in our 70s or 80s and
be struggling with disability and
sickness ourselves. So it was
mainly dealing with her death and
thinking about what would have
happened had she not had health
insurance, children, or a partner.”
“Any group of kindred spirits
can organize a ‘Share the Care’
program.” These programs may
be especially helpful in areas with
few LGBT organizations but a
large LGBT population. “Stable
LGBT populations like in college
towns are great pockets for an
STC organization because it can
enhance the quality of life for
everyone.” STC programs have
the capacity to build relationships
and interdependent networks
of support beyond kinship lines
and across generations. “I have
seen the dismissals or devaluing
of older LGBT couples in the
medical sector: calling someone’s
partner a ‘friend’ instead of
acknowledging the true devotion
and intimacy of the couple. But
sometimes the older you get, the
harder it is to fight this crap.”
LGBT older adults face narrow
restrictions on what, and who,
counts as a “legitimate caregiver.”
Typically it is only heterosexual
formations of kinship that are
recognized as caregivers, and for
LGBT folk without family nearby,
it is increasingly difficult to age in
place. Nancy and the Tompkins
County Working Group on LGBT
Aging hope to change these rules.
“The Boomers are not going to be
quiet,” Nancy says, “Institutions
need to have their feet put into the
fire.”
Nancy K. Bereano was recently
awarded the 2008-2009 Cornell
University Public Service Center Civic
Fellowship for her development of the
“Share the Care” program designed
for the LGBT community.
OUTING AGE 2010
spouses, daughters, and daughters-in-law—provide the majority of caregiving to
old people in this country,” research suggests LGBT elders are much more likely
to lack the assistance or aid in their daily lives that is commonly available to their
heterosexual peers.229 Although living alone is one of the highest-risk factors
leading to isolation among older adults, for elders who are aging in place, a clear
distinction exists between living alone and living in social isolation. Indeed, many
elders live alone and thrive in such environments. The pivotal difference is the
elder’s ability to participate actively in social and community life and to obtain
needed healthcare and social services. Those elders who do not or cannot
connect with public or social resources such as hospitals, senior centers and
mental health facilities are elders at risk.
Concerns discussed elsewhere in Outing Age 2010 suggest that LGBT older
adults may be more likely than their non-LGBT counterparts to experience
such social isolation. In particular, the data in the “Discrimination and Access”
section and the “Health” section imply that LGBT elders are at greater risk for
social isolation not only due to their higher rates of living alone, but also as a
result of the uneven or largely absent welcome they encounter at senior centers,
their lack of access to culturally competent healthcare and social services, and
related factors.
Given the scarcity of data on this aspect of LGBT aging, however, this section of
Outing Age largely extrapolates from data on the general population to provide
a picture of the risks and consequences of social isolation. It is reasonable
to assume that the LGBT elder population will not be in a better position in
this regard than is non-LGBT elder population, and may well be in a worse
position. Quantitative studies are greatly needed to further elucidate the issue
of social isolation for LGBT older adults in general—and to identify any possible
differences between lesbian, gay, bisexual and transgender elders in this regard.
Research on the general elder population suggests that the harmful effects of
social isolation extend to all geographical regions of the United States. The
general studies also confirm that social isolation leads to a number of mental
and physical ailments greatly lessening elders’ quality of life; these include
“depression, poverty, re-hospitalization, delayed care-seeking, poor nutrition,
and premature morality.”230 The New York City Department of Health and Mental
Hygiene reports that “elders with high scores on social isolation scales are
229 Cahill, S., South, K. & Spade, J. (2000), p.41.
230 Sederer, Lloyd. “Depression, Social Isolation, and the Urban Elderly.” Conference on Geriatric
Mental Health, New York City, May 18, 2006. Conference Presentation.
91
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CAREGIVING, SOCIAL ISOLATION, AND HOUSING
more likely to report depression than elders with low scores.”231 Diagnosing and
treating these elders, however, remains difficult as “elders utilize mental health
services less than any other age group,” suggesting that isolated older adults
are even less likely to use these services than their more socially integrated
counterparts.232
Research also suggests that social isolation can cause and exacerbate physical
harm. Isolated elders who have experienced an injury may be unable to summon
help, and those with chronic conditions may not receive preventive care and
effective monitoring. Likewise, recent research indicates that older adults who
are isolated are more likely to suffer from elder abuse, presumably because the
perpetrator is the sole contact in the elder’s life or because the elder has little or
no opportunity to report the abuse to others.233 Finally, some recent work shows
that isolated older adults are more prone to alcohol abuse, implying that the
higher rates of depression among these elders is channeled through misuse of
alcohol.
Given the income and benefits disparities associated with aging for the LGBT
population as documented elsewhere in this report, LGBT elders may face a
high probability of social isolation. Research on the general population suggests
that class may be correlated with isolation patterns. A study on poverty and
aging argues that elders who are poor are more likely to be isolated, as “elders
with a higher socioeconomic status have more opportunity to nurture their
social relationships” because they have “more freedom to entertain in their
homes, take classes, travel and visit with others, and use the telephone freely.
In addition, they can pay for the specialized supportive services that they may
need as they age.”234
Extrapolating from studies on poverty in the general population, it is likely that
the risk of social isolation may be particularly high for LGBT elders who live only
on Social Security, LGBT elders of color, and older lesbian and bisexual women.
231 Sederer, L. (2006, May 18).
232 Sederer, L. (2006, May 18).
233 See Cook-Daniels, L. LGBT Seniors- Proud Pioneers: The San Diego County LGBT Senior
Healthcare Needs Assessment. Retrieved September 21, 2009, from www.sage-sd.com/
SeniorNeedsAssessment. Daniels also posits that the fear or threat of “outing” the elder may
prevent them from reporting the violence.
234 Walker, Jessica, and Cara Herbitter. (2005). Aging in the Shadows: Social Isolation among
Seniors in New York City. United Neighborhood Houses: New York. Retrieved September 21,
2009, from www.unhny.org/advocacy/pdf/Aging%20in%20the%20Shadows.pdf
OUTING AGE 2010
Data has consistently shown that most elders’ income is directly derived from
Social Security, but these benefits accrue on average to $13,000 per year,
leaving elders who heavily depend on Social Security in the near-poverty
bracket.235 Women experience higher rates of poverty than men, and people
of color experience higher rates of poverty than their white peers. Assessing
these rates alongside the fact that “those living alone had the highest poverty
rate (33%)” suggests that poor women of color are likely to compose the largest
portion of those isolated.236
Physical immobility may also be a source of increased isolation among
LGBT elders. Particularly fragile or vulnerable elders may shun leaving home
altogether; something as simple as an uneven sidewalk can hinder an elder’s
ability and desire to leave the relative safety and comfort of home. Similarly,
disabilities increased the likelihood of isolation, as limited mobility prevents or
discourages elders from leaving home. One study reported that 34% of older
adults in New York City had “physical disabilities that affected walking, climbing
stairs, reaching, lifting, or carrying; 23% had conditions that restricted their
ability to go outside the home, shop, or visit the doctor.”237
Fear of victimization likewise contributes to social isolation. The New York
Academy of Medicine reported elders “fear crime and would like a more visible
police presence on the streets because as older people they are often frail and
therefore ‘easy targets’.”238 This fear of attack or imminent physical assault
breeds fear and distrust of others, limiting elders’ access to outside resources
and relationships on a continual basis. As outlined earlier, the threat of hate
crimes and other risks of violence faced by LGBT older adults make fear of
victimization a particular concern.
Finally, isolated elders may face stigmatization by services providers and
informal caregivers, who may question why these older adults would “do that
235 “Near-poverty” is classified as an income falling between the official poverty line and 125%
within the poverty line.
236 Lloyd Sederer’s research presented in May of 2006 suggests similarly, arguing his research
implicates the elders who are most isolated are “more likely to be female, Hispanic, unmarried,
poorly educated and poor.” The 2009 federal poverty guideline for one person is an income of
$10,830 annually; $14,570 for two; and $22,050 for a family of four.
237 New York City Department for the Aging (September 2008), p.12.
238 New York Academy of Medicine. (2008). Toward an Age-Friendly New York City: A Findings
Report. Retrieved September 24, 2009, from www.nyam.org/initiatives/docs/AgeFriendly.pdf,
pp.19-20.
93
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CAREGIVING, SOCIAL ISOLATION, AND HOUSING
to themselves.” This sentiment belies the reality stated succinctly in one recent
report: Those who have “the weakest capabilities and greatest needs are the
least likely to get them [addressed].”239 In other words, factors such as race,
class, sexual orientation, and gender identity—as well as the ways in which
these identities are institutionally devalued or denied—all forge a path to social
isolation in old age.
Given the lack of empirical research on social isolation among LGBT elders
and given the inherent difficulties in studying a phenomenon that intrinsically
reflects social invisibility, we cannot provide a clear estimate of the impact of
social isolation on LGBT elders. At the most rudimentary level, studying the
isolated requires that researchers have contact with the subjects in question—
yet those who are in communication with researchers are, to some degree, still
socially integrated and relatively accessible. With so little federal commitment to
studying LGBT elders in general, identifying and serving isolated LGBT elders
is yet another monumental task currently left to a handful of underfunded LGBT
organizations and programs.240
HOUSING
Creating LGBT-targeted and LGBT-friendly elder housing is a scarcely developed
yet important option for enabling our elders to age in their own communities,
avoid isolation and receive culturally competent care. Gerontologist Brian de
Vries stresses the importance of this issue for LGBT elders: “Home is a weighty
term, packed with reference to everything from the physical and environmental
space surrounding an individual to his or her psychological and emotional
space. Such multidimensionality is infrequently noted in the considerations
of housing for older people. However, issues of housing and the older LGBT
population mandate such considerations, given the legacy of harassment and
239 Klinenberg, E. (2003). Heat Wave: A Social Autopsy of Disaster in Chicago. Chicago: University
Of Chicago Press, pp.142-143.
240 Eric Klinenberg similarly noted this irony in his own research for Heat Wave: “It is difficult to
measure the number of people who are relatively isolated and reclusive. First, isolates and
recluses are by definition difficult to locate and contact because they have few ties to informal
or formal support networks or to researchers; second, isolated or reclusive people who are
contacted by researchers often become more connected through the research process. In
surveys and censuses, isolates and recluses are among the social types most likely to be
uncounted or undercounted because those with permanent housing often refuse to open their
doors to strangers and are unlikely to participate in city or community programs in which they
can be tracked. In academic research it is common to underestimate the extent of isolation or
reclusion among elders because most scholars gain access to samples of elderly people who
are already relatively connected.” p.45.
OUTING AGE 2010
discrimination that many LGBT elders have endured and their associated need
for a safe home-base retreat.”241
From its earliest days, the LGBT movement in the United States has recognized
this need: The first mention of plans to build specialized housing for gay older
adults appeared in the homophile publication One Magazine in 1956.242 That
project never came to fruition, but now, more than a half-century later, at least
eight LGBT elder housing communities are in existence, and approximately
20 more are in various stages of planning.243 In addition, a number of general
elder housing facilities have established LGBT-friendly policies and practices,
and several initiatives are under way around the country to advocate culturally
competent care for LGBT elders in the full range of existing senior housing.
The emergence of LGBT-specific and LGBT-friendly housing options is a positive
sign, but the small number and scattered geographical distribution of these
projects is at the same time cause for concern. Given the demographics of
the older LGBT population as discussed elsewhere in this report, government
agencies, for-profit and nonprofit housing developers, and existing providers
of housing nationwide will be required to take action to address LGBT elders’
largely unmet needs for homes where they can age with support, dignity and
respect.
HOUSING: Housing Options for LGBT Older Adults
The majority of Americans hope to age in place in the homes where they have
always lived—yet to make this possible, most will ultimately need varying
degrees of home and community-based services. In addition to those who
241 DeVries, B. (2004). “There’s No Place Like Home: Needs Assessments Look at Housing
Services for LGBT Elders.” OutWord 11(2), pp.4—5, 8.
242 McIntire, D. (1956, April-May). “Tangents: News and Views.” One Magazine. Retrieved
September 16, 2009, from www.asaging.org/asav2/asaconnection/enews/07june/documents/
One1956.pdf.
243 Koskovich, G. (2009, February 23). “LGBT Retirement Housing.” Unpublished table prepared
by Gerard Koskovich for the LGBT Aging Issues Network (LAIN), available in the LAIN subject
files at the GLBT Historical Society in San Francisco (collection no. 2008-02; file: “Housing—
Clippings: ASA Publications & Backgrounders”). The numbers do not include cohousing
projects, mobile home parks or board-and-care homes. An earlier version of this table
appeared in Kennedy, L. (2007, November 25). “Living Out the Golden Years: New Facilities
Across the U.S. Offer the Serenity of Bias-Free Retirements.” Denver Post. Retrieved from
www.denverpost.com/lifestyle/ci_7550872.
95
96
CAREGIVING, SOCIAL ISOLATION, AND HOUSING
The majority
of Americans
hope to age
in place in the
homes where
they have
always lived.
are aging in place, many older adults prefer or require
specialized housing, in settings ranging from independent
living to assisted living to skilled nursing.244
In a meta-analysis of findings from more than a dozen local
and regional needs assessments focused on LGBT elders
around North America, gerontologist Brian de Vries reports
that, “As with older adults in general, respondents valued
highly the promotion and maintenance of independence.
To meet [this need], respondents in several of the studies
proposed the development of LGBT-friendly in-home
supports; the development of a welcoming residential
community was also frequently mentioned. Most important,
many of those who responded to questions regarding
preparations for late life commented that their strong
preference was for LGBT-affirmative and LGBT-predominant
housing—though not necessarily LGBT-exclusive housing—
and for environments that connect generations and
communities.”245
Since the mid-1990s, options have emerged across the
United States in response to a growing awareness of the
housing needs of LGBT elders. These options include
targeted in-home services, market-rate and affordable LGBTspecific and LGBT-friendly retirement communities, licensed
board-and-care homes, and initiatives to promote cultural
competence in the wide range of existing senior housing
facilities.246 Despite the diversity of models for establishing
LGBT elder housing, the number and geographic distribution
of programs and facilities remains quite limited.
244 “Assisted living” refers to the situation of many elders or people with disabilities who operate
independently for the most part but who may need help with some activities of daily living, or
simply prefer the convenience of having support. “Requiring skilled nursing” refers to those
with a continuing need for nursing support and qualify for certain benefits under Medicare.
245 DeVries, B. (2004). “There’s No Place Like Home: Needs Assessments Look at Housing and
Services for LGBT Elders,” OutWord 11(2), p. 4—5, 8; cite at pp. 5, 8.
246 A Board and Care Home is a type of elder housing for those who want or need to be in a
group living situation and who may need assistance with personal care and living activities
intermittently but not constantly throughout the day.
OUTING AGE 2010
HOUSING: Homecare
As frailty, disability or chronic illness reduces the capacity to handle everyday
chores such as shopping, cooking and cleaning and to carry out activities of
daily living such as bathing or getting in and out of bed; many older adults can
nonetheless retain a degree of independence and remain in their own homes if
they receive needed assistance. For some, informal caregivers such as family
members and friends are available to help; others require formal care provided by
paid homecare workers.
Given the data presented elsewhere in Outing Age 2010 regarding LGBT elders’
tendency to live alone and to be separated from biological family, many would no
doubt benefit from services to support aging in place. At the same time, LGBT
older adults may hesitate to admit homecare workers into their homes because
they fear exposure, discrimination or disapproval in one of the few places where
they can truly be themselves.247
To address this concern, a number of LGBT organizations have established
local friendly visitor programs and chore assistance networks. Philadelphia’s
“Connecting Generations” program, run out of the William Way Center, offers
intergenerational friendly visiting programs and chore assistance to homebound
LGBT older adults, for example, while GRIOT Circle’s “Buddy to Buddy” program
matches older LGBT people with a homebound elder to ensure an ongoing
connection with community through friendship and social support.248 In addition,
a handful of explicitly LGBT-friendly for-profit homecare services have entered
the marketplace in major urban areas. The demand for LGBT-affirmative in-home
services, however, no doubt significantly outstrips the still very limited supply.
HOUSING: Assisted Living
To date, only one LGBT-targeted retirement community—the for-profit
RainbowVision in Santa Fe—offers assisted living units. As a consequence,
virtually all LGBT older adults throughout the United States who find that they
require a residential setting offering 24-hour formal care are obligated to move
into assisted living facilities for the general population. Given that mainstream
residential and care settings and providers are largely unprepared and ill-informed
of the needs of their LGBT clients and residents, mandated trainings and
247 Funders for Lesbian and Gay Issues. (2004).
248 The GRIOT Circle’s program is designed specifically for LGBT people of color. In Ithaca, New
York a rural visitor program, “Share the Care” has been established and provides a replicable
model for advocates organizing services for rural LGBT elders, see profile on page 90.
97
Karen Dickinson Los Angeles, California, 66
A year later, Karen moved in with
her first partner, Robin, and her
ex-husband began asking pointed
questions about the relationship.
He asked their sons how many
beds were in the house, which
people slept in which beds, and
how their mother interacted with
Robin. Soon, he attempted to
remove the boys from Karen’s
home.
I
n total, Karen has moved 63
times, nearly one move for every
year of her life. Born in Akron,
Ohio in 1943, Karen left at age 18,
escaping a toxic and unsupportive
family environment. Once in
California, she settled into a cozy
abode in Huntington Beach and
got her first job at Denny’s Diner.
She remembers with fondness the
minimal cost of living then, and
how she and her friends easily
supported their social lives.
A year later, in 1962, Karen
packed up her things and headed
back to Ohio. She soon married
and had two sons. Her husband
was a traveling salesman so they
moved fairly frequently, from Ohio
to Chicago, Columbus, Kansas
City, and kept moving until 1974.
It was around this time that Karen
realized she was a lesbian. She
subsequently divorced, and her
two sons, then 5 and 9, began
splitting their time between their
parents.
“I felt like I was free-falling. I had
no idea what to do so I packed up
all of the things that I could and
took the boys and caught a flight
in the middle of the night. I didn’t
tell anyone where we were going.
We went to Hawai’i. I had no idea
what I was doing.”
Karen was quickly apprehended.
“My sons were immediately
taken from me and given to my
ex-husband and his new wife
and under my father’s orders, I
was taken to a mental institution
without delay or hearing.”
Eventually Karen did hire a lawyer
and secured visitation rights. “I
got to see them four times a year
in Wisconsin, and it was always
under supervised conditions.”
In 1978, the boys permanently
came home to live with me in
Akron, and I introduced them to
my girlfriend, and I told them that
this was a big deal, and that they
could never tell their father about
her. They didn’t, and from then on,
they lived with me.”
Karen continued to move across
the country. She remembers
feeling vulnerable when men
found out she was a lesbian living
alone; she was physically and
verbally harassed, accosted, and
intimidated for being gay.In 2000,
she moved to Los Angeles, where
she found the country’s first-ever
affordable residential housing
for LGBT elders. Conceived by
Gay and Lesbian Elder Housing,
Triangle Square was specifically
designed for older adults on a
fixed or low-income scale.
Triangle Square has daily, weekly,
and monthly activities, including
artwork, sculpting, writing classes,
yoga, and game nights. At the
end of the month, there will be a
celebratory art show, complete
with wine and cheese.“I’ve been
here now about two years, and it’s
mine until I die or need assisted
living. My current project is to get
people together on our floor and
get to know each other on a name
by name basis, so whenever there
is a need for help, we can just ask
each other. I think a lot of people
are still isolated here, even though
there are surrounded by other
LGBT people.”
OUTING AGE 2010
significant changes in policies and practices are essential to ensure that assisted
living facilities provide culturally competent care to LGBT elders.
A 2005 study by M. J. Johnson and colleagues offers a snapshot of lesbian and
gay viewpoints on these issues by surveying a sample of 127 respondents. Thirtyfour percent said they thought hiding their sexual identity would be necessary if
they moved to a retirement home; 93% felt that this problem would be mitigated
by the development of staff diversity training including a lesbian and gay
component; and 83% thought such training would build tolerance of lesbian and
gay individuals not only among staff but also among other residents.249
Such training programs show much promise in raising the awareness of providers
regarding the needs of LGBT elders in their care. One example is Project Visibility,
an initiative of Boulder County Aging Services in Boulder, Colorado, which works
to create safe environments for LGBT older adults by educating providers of
assisted living and other elder services and helping them develop policies and
practices to protect residents from discrimination. In a 2006 survey of those who
had taken the training, Project Visibility found an extremely high level of success:
Eighty-four percent of the 110 respondents reported an increased awareness of
LGBT aging issues, and 78% better understood the fears experienced by some
LGBT elders.250
Most respondents also said that the training helped them keep from making
assumptions about their clients’ identity, families, or marital status. The training led
24% of the participating agencies to revise their marketing, applications or other
materials, and 18% changed policies or procedures to be more LGBT inclusive.
Many agencies also reported making changes in ongoing employee trainings and
posting materials provided in their facility which they had received from Project
Visibility. As a result of these workplace changes, over a quarter of respondents
felt staff communication had improved, 34% felt that the administration was more
culturally competent and aware, and one fifth said LGBT staff members felt more
included. Perhaps the biggest success was the fact that 11% of those surveyed
reported clients becoming more open with them about their sexuality.251
249 Johnson, M. J., Arnette, J. K., & Koffman, S. D. (2005). “Gay and Lesbian Perceptions of
Discrimination in Retirement Care Facilities.” Journal of Homosexuality 49(2).
250 Boulder County Aging Services Division. (2006). Evaluation of Project Visibility Training:
Outcomes and Satisfaction. Retrieved July 28, 2008, from www.projectvisibility.org.
251 Boulder County Aging Services Division. (2006). Evaluation of Project Visibility Training:
Outcomes and Satisfaction. Retrieved July 28, 2008, from www.projectvisibility.org.
99
100
CAREGIVING, SOCIAL ISOLATION, AND HOUSING
HOUSING: Naturally Occurring Retirement Communities
Naturally occurring retirement communities (NORCs) offer an innovative model
for LGBT elder communities that show much promise for widespread use in
cities nationwide. A NORC can develop when individuals choose to age in
their homes in single neighborhood or even single buildings, or can be the
result of older individuals relocating near one another. In this situation, housing
is “naturally occurring” rather than designed for elders, wherein adults form
communities that fulfill the practical, psychological, and social needs required
to age with dignity and independence.252 The NORC model was pioneered by
Jewish communities in U.S. cities where naturally occurring concentrations of
elders in a given locale were recognized through federal grants that enabled the
communities to benefit from supportive services such as mobile healthcare units
and senior centers.253
Drawing on this model, SAGE has established a NORC in New York City’s
Harlem neighborhood. SAGE obtained funding from the State of New York
to establish a staffed drop-in site where elders can learn about activities
taking place in the community and can connect with their neighbors. LGBT
Harlem residents have varying levels of openness about their identities, so
the organization has worked to earn the trust of the close-knit community and
to learn what services the elders most need. SAGE has partnered with other
long-established community-based organizations in the area to provide health
screenings and legal clinics among other services. SAGE staff report that
community socials have been the most popular events, with some drawing as
many as 100 participants.
252 SAGE Harlem. SAGE Harlem NORC Fact Sheet. Retrieved September 16, 2009, from www.
sageusa.org/uploads/Microsoft%20Word%20-%20SAGE%20Harlem%20Neighborhood%20
NORC%20Fact%20Sheet%20-%20Jan%2008.pdf.
253 Altman, A. The NORC Supportive Service Program. United Jewish Appeal Federation of New
York. Retrieved October 14, 2009, from www.wcjcs.org/QC2007/Materials/The%20NORC%20
Supportive%20Service%20Program%20-%20Anita%20Altman.pdf ; Masotti, et al. (2006).
Healthy Naturally Occurring Retirement Communities: A Low-Cost Approach to Facilitating
Healthy Aging. American Journal of Public Health 96. Retrieved from www.ajph.org/cgi/content/
full/96/7/1164?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Masotti&searchid
=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT.
OUTING AGE 2010
HOUSING: LGBT-Targeted Elder Housing
Since the mid-1990s, a handful of LGBT-targeted retirement communities
have opened in the United States. Starting in 1997 with Palms of Manasota in
South Florida, an initial group of for-profit projects offered lots for sale on which
buyers could construct their own homes; purchase of the lot and payment
of a monthly fee provided membership in a homeowners association offering
access to shared facilities such as a community clubhouse and landscaped
open spaces.254 Individual developments of this sort subsequently opened in
New Mexico and North Carolina, as did a manufactured-housing “resort and
retirement community” for lesbian women in South Florida.
During the same period, for-profit and nonprofit developers launched initiatives
to build full-scale retirement communities tailored to the needs of LGBT older
adults. These projects were planned as amenity-rich communities offering a
village-style mix of housing or a large multi-unit building, ready for purchase
or rental. In addition, three for-profit projects that involved rehabilitating former
hotels to serve as multi-unit LGBT elder housing made it to the point of briefly
opening for business: Barbary Lane Senior Communities in Oakland, CA;
Calamus Communities in Phoenix, AZ; and The Racquet Club in Palm Springs,
CA. Each closed within months for reasons that were not publicly announced.
Although studies show that a for-profit market exists for LGBT elder housing,
the challenges of finding investors and financing, purchasing suitable land,
and obtaining permits and licenses have proved insurmountable for the two
or three dozen such projects that were announced but never went beyond
the predevelopment stage.255 Similarly, although needs assessments show a
strong community interest, only one nonprofit to date has succeeded in putting
together the public funding and private donations and solving the logistical
issues involved in opening affordable housing for LGBT older adults.256
254 Visit the Palms of Manasota website at www.palmsofmanasota.com. Visit the RainbowVision
website at www.rainbowvisionprop.com.
255 For an example of market research, see Dwight, M. (2004). “Searching for the Sample:
Researching Demand for Senior Housing in the LGBT Community.” OutWord 11(2), pp.2,8.
256 On needs assessments, see DeVries. (2004).
101
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CAREGIVING, SOCIAL ISOLATION, AND HOUSING
Despite the considerable challenges to creating such projects, approximately
eight LGBT-targeted elder housing communities are currently open, and
approximately 20 more are in various stages of planning. Only one of the
existing facilities, Triangle Square in Los Angeles, is a nonprofit offering
affordable housing. The others offer various forms of market-rate housing,
ranging from the relatively low-cost RainbowVista in Gresham, Ore., to the highend RainbowVision in Santa Fe. The small number of these projects makes
it clear that both affordable and market-rate LGBT-specific housing remain
exceptionally underdeveloped segments of the field of elder housing overall.
Clearly, the past decade has seen a great deal of innovative thinking and action
in the arena of organizing LGBT housing for elders. Nonetheless, affordable
LGBT-affirming or LGBT-centric housing options do not exist for the vast
majority of the nation’s LGBT elders who seek them. While the majority of
initiatives in LGBT housing have been in the for-profit arena, the economic
vulnerabilities experienced by LGBT elders over the lifespan documented here
indicate that culturally competent, LGBT-affirming public and affordable housing
options are most sorely needed. The emergence of NORCs is a bright spot on
the housing horizon, offering possible organizing strategies in neighborhoods
with heavy concentrations of LGBT elders. However, since many LGBT people
of color tend to settle into neighborhoods along the lines of their racial/ethnic
identities rather than their LGBT identities, the NORC model may be more
likely to serve LGBT elders living in urban “gayborhoods” than elders of color
— the Harlem NORC seems to be a wonderful exception. Ten years from now,
when the Task Force revisits this document for a second update, the LGBT
elder boom will be in full flower — the crisis in housing presented here must be
mitigated by vastly improved mainstream assisted living care and services, a mix
of public and private LGBT-affirming housing options, and a thriving network of
LGBT-centric NORCs.
OUTING AGE 2010
POLICY RECOMMENDATIONS
To address LGBT elders’ needs for caregiving, social integration and housing,
The Task Force calls on legislators, public agencies, providers of health and
mental health services, and community advocates to take the following steps:
•
Governmental agencies at the federal, state and local levels must facilitate
innovative funding programs for LGBT-targeted and LGBT-affirming
affordable and low-income housing.
•
Amend the Fair Housing Act and other housing laws to include specific
non-discrimination policies that protect LGBT people, and tie the receipt of
federal and state funding to compliance.
•
Call upon the U.S. Department of Housing and Urban Development (HUD)
to enforce its LGBT anti-discrimination regulations and to require grantees in
elder housing to obtain certification as culturally competent to serve LGBT
elders.
•
Amend the federal Family and Medical Leave Act to cover LGBT caregivers
and their family and friends, regardless of whether they are related by blood
or marriage.
•
Reach out to LGBT caregivers to inform them about services they can
receive from the National Family Caregiver Support Program.
•
Develop policies, practices, and training within caregiver programs to ensure
that staff are willing and able to support LGBT caregivers.
•
Fund and develop programs that are specifically designed to address the
needs of LGBT caregivers and of caregivers for LGBT older adults.
•
Fund and develop programs that are specifically designed to address social
isolation among LGBT elders, such as LGBT-specific and LGBT-affirming
friendly visitor programs.
103
104
CIVIC ENGAGEMENT, EDUCATION AND WORK
CIVIC ENGAGEMENT, LIFELONG LEARNING
AND ELDERS IN THE WORKFORCE
Too often, older adults in the United States are regarded as a population with
little prospect for learning, growing and contributing to society. Aging often
is viewed largely as an assemblage of losses and needs, with elders seen as
burdens, soaking up resources that could be better used elsewhere. The reality
is far different from these popular misconceptions: older adults in fact retain the
capacity to learn, to develop the wisdom of experience, and to make positive
contributions to their communities as volunteers. In addition, a considerable
percentage of those ages 65-plus remain productive in the economy, either by
choice or necessity.
CIVIC ENGAGEMENT
One of the forces working to reverse the widespread stereotype of older adults
as social burdens is the civic engagement movement, which focuses on the
strengths and contributions of older people. One advocate explains civic
engagement as “actions wherein older adults participate in activities of personal
and public concern that are both individually life enriching and socially beneficial
to the community.”257 Such civic engagement not only serves the people,
organizations and communities with whom older people work, but also helps
older adults themselves: Studies have shown that older adults who regularly
volunteer lower their risk of mortality and have better physical and mental
health.258
Many LGBT aging organizations were founded and built to a significant degree
by LGBT older adults, and are thus emblematic of the extraordinary benefits of
civic engagement. Anecdotal evidences suggests that LGBT people in midlife
and older adults continue to play vital roles as community organizers, policy
advocates, nonprofit board members, and frontline volunteers in an array of
initiatives across the country. Recognizing the value of sustaining and building
such involvement, a handful of LGBT groups have launched programs to
formally encourage civic engagement among elders; at least a few non-LGBT
organizations have likewise made targeted efforts to involve LGBT older adults
as volunteers in initiatives that reach beyond the LGBT community.
257 Culliane, Patrick. “Late-Life Civic Engagement Enhances Health for Individuals and
Communities.” The Journal on Active Aging. (2006): 66-72.
258 Cullinane, P. (2006).
OUTING AGE 2010
A program from the San Francisco Bay Area offers one model for such
programming: The Leadership Academy of Lavender Seniors of the East Bay
in San Leandro, CA, provides an annual daylong training on how elders can get
involved in local government advisory boards. Another Bay Area nonprofit, the
Family Service Agency of San Mateo, recruits LGBT elder volunteers as part
of its diversity outreach for senior peer counselors. And in the Boston area,
Americorps volunteers have met with older adults from the LGBT Aging Project
to invite their participation in the Experience Corps program which enlists elders
to help public school students learn to read.259
Civic engagement can take many forms. Existing national programs for older
adults sponsored by the federal government include the following:
•
The Retired and Elder Volunteer Program (RSVP), which has recruited nearly
half-a-million Americans ages 55 and older to serve in 65,000 nonprofit
organizations, public agencies, and faith-based institutions.
•
Foster Grandparents, which employs 30,000 low-income older Americans
to help young mothers and abused children and to work in drug treatment
settings, daycare centers, and Head Start programs.
•
The Elder Companion program, which assists homebound and frail elders.260
These programs are modest efforts when measured against the resource
represented by older adults who are not fully involved as volunteers or who want
deeper engagement with their communities. Professionals and organizations in
the field of aging are increasingly piloting programs and undertaking research to
determine how to best increase civic engagement among older adults. To reach
their full potential, these initiatives must provide a culturally competent welcome
to LGBT elders, whose experience, wisdom and skills stand to benefit not only
the LGBT community but also the community as a whole.
259 For the programs mentioned, see: “Lavender Seniors of the East Bay. (2009). Civic Minded
Seniors Get Involved.” Lavender Notes 14(4), p.1. Retrieved from www.lavenderseniors.
org/newsletters/2009-04.pdf; Aragon, J. (2009, March 29). Help Available for Coastside
Seniors Who Lost Medical Care. San Mateo County Times; LGBT Aging Project. (2009,
March). New Faces and Places at the LGBT Meal Sites. Do Tell: The LGBT Aging Project’s
Monthly Newsletter. Retrieved from archive.constantcontact.com/fs087/1101765436976/
archive/1102481189561.html.
260 Achenbaum, WA. “A History of Civic Engagement of Older People.” Generations. 30.4 (2007):
18-23.
105
Marc Anderson Hampton Roads, Virginia, 60
thereafter, tomorrow.” Alongside
all this, Marc had a growing
recognition that he was gay.
N
ot a week goes by that
Marc Anderson doesn’t
have an exciting church
engagement planned. Indeed,
as a current member of the New
Life Metropolitan Community
Church of Hampton Roads,
he will typically have Church
Choir practice on Monday
night, a Church Board Meeting
on Wednesday night, a Biblestudy on Thursday night, social
events on Friday and Saturday
nights, and a service on Sunday
mornings! Since joining New
Life MCC in 2000, Marc says
he has finally found a “personal
fit” between his personal and
religious sides, bringing both into
a strong, unified life.
But Marc remembers that his
relationship with religion has
waxed and waned over the years.
Born into “a maternal Baptist
and paternal Methodist family,”
he remembers that his first
introduction to religion involved a
lot of “the traditional gloom and
doom of the day, and the wait,
repent, and prepare for the better
As a black youth living in Harlem,
Marc discovered the area’s
thriving gay male community and
completely immersed himself in
it. “The bars in Harlem became
my stomping grounds. There,
among many other black gay
men, I met the elite black church
folks—the musicians, the singers,
and my own real Uncle Oliver,
who was a very successful Black
Educator and church musician,
included in the mix. These people
rendered unto Caesar during
the week, but then gave it up to
their God on Sunday mornings.
From them, I learned it was okay
to be gay and Christian, and I
began to see the connections
between their sexuality and their
religion. I developed a relationship
with the Minister of Music at the
Abyssinian Baptist Church, and I
attended and learned a lot.”
Now, as an active member in
his MCC, Marc sees a growing
and welcoming trend between
communities of faith and sexual
identities. “There are more
affirming churches out there:
MCC, UCC (United Church of
Christ), Unitarian, the Fellowship
Churches. Now, LGBT people
can be who we are meant to be:
part of God’s rainbow of people.
There are also new theologies out
there like Liberation, Feminist,
Queer, and others that are now
being taught in Seminaries and
Schools of Knowledge and
Thought. New clergy candidates
and older mature clergy are
studying, learning, and applying
these theologies to our 21st
Century world. LGBT people are
everywhere and people need to
deal with those realities.”
For Marc, “The most important
change I have seen in the last
ten years is the desire for, and
the establishment of, direct
interaction between different
faith communities and the LGBT
religious community.” And he
has lived to see, and experience,
the intertwining of the two
worlds. “I have two stand-out
affirming experiences. The first
was Our Holy Union in 2005 with
my partner, Allan, of 8 years,
performed by MCC clergy in the
Sanctuary of St. Mark’s Episcopal
Church in Hampton, VA. The
second was becoming one of
the 18,000 same-sex couples
who said, ‘I do!’ in California in
2008. I never thought I would
marry—much less be a part of a
living history that may change our
social customs. It goes to show,
‘With God, all things are possible.’
-Matthew 19:26.
OUTING AGE 2010
LIFELONG LEARNING
Honoring the ongoing individual worth and social involvement of older adults
also is a central principle of the lifelong learning movement. As with civic
engagement, studies have demonstrated that active participation in learning
contributes to the cognitive health and social well-being of older adults and
supports their ongoing involvement in their communities.261 Education, arts
and humanities, and intergenerational programs for older adults are sponsored
by senior centers, colleges and universities, and other institutions around the
United States. Two particularly influential and well-funded initiatives in this area
are the educational travel nonprofit Elderhostel and the nationwide network of
Osher Lifelong Learning Institutes.262
Until quite recently, lifelong learning programs overall made no visible effort to
provide a culturally competent welcome to LGBT older adults or to address
LGBT issues in their educational offerings. Even today, most such programs for
the general population appear to provide little or no outreach or programming
targeted to LGBT elders. A few organizations and agencies around the U.S.
have, however, played an exemplary role in addressing this gap. In the Boston
area, Wheelock College has partnered with Stonewall Communities, a local
LGBT nonprofit, to launch a lifelong learning institute specifically tailored to
LGBT older adults.263 Similarly, the Boulder County Aging Services Division, an
area agency on aging in Colorado, has organized art classes, grief workshops
and other educational opportunities for LGBT elders at local senior centers.264
261 See, for example, Gillespie, A., & Gottleib, B. (2008). “Volunteerism, Health, and Civic
Engagement among Older Adults.” Canadian Journal on Aging / La Revue Canadienne du
Vieillissement 27(4).
262 Visit the Elderhostel website at www.elderhostel.org; visit the Osher Lifelong Learning Institutes
home page at www.usm.maine.edu/olli/national/about.jsp.
263 Visit the Stonewall Communities Lifelong Learning Institute website at www.sites.
stonewallcommunities.org/www/lli.
264 De Anni, T. (2007). “Looking Ahead to 2008.” Rainbow Elder News 3(4). Retrieved from www.
bouldercounty.org/cs/ag/pdfs/rainbow_news_3_4.pdf.
107
108
CIVIC ENGAGEMENT, EDUCATION AND WORK
Likewise stepping into the breach in the past decade are a number of LGBT
community centers and other LGBT organizations. Three California programs
offer examples:
•
SAGE Palm Springs offers ongoing older adult education in such subject
areas as art, computer skills, cooking, creative writing, and languages.265
•
The Los Angeles Gay and Lesbian Center offers weekly art, computer skills,
and exercise classes specifically for elders—and provides a discount for
those ages 55-plus who enroll in any of the center’s general adult education
courses.266
•
Frameline, the nonprofit that sponsors the San Francisco International LGBT
Film Festival, hosts the Generations Film Workshop, an annual eight-week
program that brings together LGBT elders and youth to learn media literacy
and technical skills and to jointly create short films about their experiences.267
The efforts of these organizations undoubtedly benefit the elders who
participate, yet the fact remains that such programs are largely or completely
unavailable in most parts of the United States. To ensure full participation by
all interested elders, lifelong learning initiatives throughout the country must
develop culturally competent outreach and culturally relevant courses for LGBT
older adults. To ensure the well-being of all their clients, LGBT community
centers and other LGBT organizations likewise would do well to create
opportunities for lifelong learning for our elders.
WORKFORCE ISSUES
In addition to opportunities for civic engagement and lifelong learning, paid
employment is a concern for many older adults, a significant percentage of
whom continue working beyond the traditional retirement age of 65. In 2007,
16% of Americans ages 65-plus (5.8 million people) were in the labor force,
whether employed or actively seeking work; this percentage has been rising for
265 Visit the programs page of the Golden Rainbow Senior Center website at
www.goldenrainbowseniorcenter.org/programs.html.
266 Visit the Seniors Services page of the Los Angeles Gay and Lesbian Center at www.
lagaycenter.org/site/PageServer?pagename=YW_Seniors_Program.
267 Visit the Generations Film Workshop home page at www.frameline.org/filmmaker-support/
workshops.
OUTING AGE 2010
both men and women for nearly a decade.268 Some of these individuals wish to
remain economically productive because they hold satisfying jobs and are not
yet interested in retiring. Others are required to continue working because they
lack sufficient resources to retire—an issue that has become increasingly salient
as the current economic downturn exacerbates the economic vulnerability of the
older adult population.
Given these circumstances, ongoing productive work certainly remains a
concern for many LGBT people ages 65-plus. Indeed, a national survey
conducted in 2006 found that 27% of LGBT Americans in the baby boom
generation expect to retire sometime in their 70s.269 The issues of poverty and
the economic effects of lifelong job discrimination discussed elsewhere in this
report suggest that remaining in the workforce as a matter of necessity may
be a particularly significant issue for LGBT elders. Efforts to pass the federal
Employment Non-Discrimination Act of 2009 (ENDA), which would ban job
discrimination against LGBT people of all ages and across all states, will have
particular significance for LGBT older adults, as do assertive enforcement and
enhancement of existing laws banning age discrimination in the workplace.
For as long as they remain in the workforce, whether by choice or as a result of
financial need, LGBT elders must be ensured the fairness and respect that all
workers deserve.
268 US Department of Health and Human Services, Administration on Aging. (2008). A Profile
of Older Americans: 2008. Retrieved August 29, 2009, from www.aoa.gov/AoARoot/Aging_
Statistics/Profile/index.aspx, p.12.
269 Metlife Mature Market Institute, Lesbian and Gay Aging Issues Network of the American
Society on Aging, & Zogby International. (2006), p.15.
109
110
CIVIC ENGAGEMENT, EDUCATION AND WORK
POLICY RECOMMENDATIONS
To promote full civic engagement of LGBT older adults and advance the
societal benefits that such engagement would produce, the Task Force calls on
legislators, public agencies, nonprofit organizations, and community advocates
to take the following steps:
•
Develop a national strategy for promoting new and meaningful volunteer
activities and civic engagement opportunities for current and future older
adults, ensuring that such opportunities are open to all, regardless of sexual
orientation and gender identity and expression.
•
Include LGBT organizations and issues in congressionally mandated
efforts by the Administration on Aging and the Corporation for National and
Community Service to develop a comprehensive strategy for mobilizing older
adults to address critical local needs of national concern.
•
Develop and support innovative civic engagement programs involving older
LGBT people that increase their involvement in volunteer settings and in
public policy advocacy.
•
Develop culturally competent outreach and culturally relevant courses for
LGBT older adults in the full range of older adult education settings.
•
Enforce existing laws banning discrimination in employment on the basis
of age, sexual orientation and gender identity and expression to begin
correcting the workplace discrimination that costs some older LGBT adults
their jobs.
•
Pass federal and—where they do not currently exist—state and local laws
banning employment discrimination on the basis of sexual orientation or
gender identity and expression to ensure that LGBT older adults have equal
access to productive work.
OUTING AGE 2010
CONCLUSION
Throughout their lives, LGBT elders have participated to the fullest extent in
American life in ordinary and extraordinary ways: through work and professional
activities, economic and cultural productivity, serving in the military, caring for
chosen and biological family, raising children and grandchildren, paying taxes,
organizing for and demanding justice, and countless other pursuits. At the same
time, these elders have been largely shut out of the basic institutional supports,
benefits and safety nets that other older Americans rely upon as foundational
commitments of our democracy.
The time has come for the nation to leave behind this history of indifference and
discrimination that has led to invisibility, vulnerability, social isolation, poverty,
poor health and early death for far too many LGBT elders. To ensure that LGBT
older adults can live with dignity, respect and full inclusion in American society,
the Task Force demands that the federal government, the states, the field of
aging and our own LGBT institutions vigorously embrace and pursue the policy
recommendations presented in this report.
We recognize that all levels of government in the United States are struggling
to restructure financial, health, and social services systems to meet the needs
of our rapidly aging nation. These efforts present a unique opportunity to
redress the flaws and biases in current policies and practices that lead to the
exclusion and marginalization of LGBT elders. New policies and legislation
must simultaneously outlaw discrimination based on sexual orientation and
gender expression or identity; recognize and support the diversity of the range
of family structures which LGBT people form; create and support culturally
competent programs that effectively address the needs of LGBT older adults;
and provide relevant training, data collection, and research so that agencies
and professionals in the field of aging can develop programs and services that
welcome, support and respect all Americans.
Accordingly, we synthesize and recap our major policy recommendations here:
111
112
KEY RECOMMENDATIONS
KEY POLICY RECOMMENDATIONS
•
The federal government and the states must fund and include questions on
sexual orientation and gender identity in all research surveys so that the specific
strengths and vulnerabilities of LGBT elders can be identified and addressed.
– Revise the administrative regulations for the Older Americans Act to
require state agencies receiving funding for data collection to gather
statistical information on LGBT populations.
– Replicate the Older Californians Equality and Protection Act in the
states — with attention to funding for its mandates — to vastly improve
state level data collection and service delivery.
– Conduct specific research on the physical and mental health
consequences of racism, economic injustice, homophobia, and
transphobia experienced by LGBT elders over the lifespan.
•
The federal Administration on Aging should issue guidelines to the states
to include LGBT elders as a “vulnerable senior constituency and identity”
and those with the “greatest social need” and provide directives for active
outreach to and inclusion of LGBT elders in state plans.
•
Pass the Employment Non-Discrimination Act (ENDA) to minimize workplace
discrimination over the lifespan so that LGBT people do not face their elder
years at an economic disadvantage. Enforce state and local employment
non-discrimination laws.
•
Enforce existing — and pass additional — state and local laws banning
discrimination on the basis of age, sexual orientation and gender identity and
expression in public accommodations such as senior centers, public housing
and nursing facilities.
•
Reframe and expand the definition of family to recognize same sex
relationships and LGBT family kinship structures in the designation of federal
benefits such as Social Security, Medicaid and Veterans Benefits.
•
Pass federal and state legislation that ensures access to LGBT-affirming
health care for people of all ages and provides appropriate care for
transgender people.
•
Amend the federal Family and Medical Leave Act to cover LGBT caregivers
and their family and friends, regardless of whether they are related by blood
or marriage.
OUTING AGE 2010
•
Amend the Fair Housing Act and other housing laws to include specific
non-discrimination policies that protect LGBT people, and tie the receipt of
federal and state funding to compliance.
•
Call upon the U.S. Department of Housing and Urban Development (HUD) to
enforce its LGBT anti-discrimination regulations and to require grantees in elder
housing to obtain certification as culturally competent to serve LGBT elders.
•
Press governmental agencies at the federal, state and local levels to
facilitate innovative funding programs for LGBT-targeted and LGBT-affirming
affordable and low-income housing.
•
Vigorously call upon and enforce the Joint Commission’s anti-LGBT discrimination accreditation rules in assisted living facilities and nursing homes to catalyze wholesale change in assisted living and nursing care for LGBT people.
•
Train public and private healthcare providers in cultural competence for
working with LGBT older adults. Tie funding, accreditation and degree
requirements in medical, nursing and social work schools to LGBT cultural
competency certification.
•
Develop and institute health promotion and healthcare-access policies and
programs specifically designed to bring needed care to older LGBT people
including, but not limited to, those living with HIV/AIDS.
•
Support a National AIDS Strategy that would include the establishment of
prevention, testing and treatment guidelines and programs designed to
specifically address the issue of HIV/AIDS among LGBT people ages 50-plus.
•
Press the Centers for Medicare and Medicaid Services (CMS) to revise their
National Coverage Determination to ensure medically-necessary treatments
related to gender transition and to remove barriers to health care related to
an individual’s pre-transition gender.
•
Reach out to LGBT caregivers to inform them about services they can
receive from the National Family Caregiver Support Program.
•
Fund and develop programs that are specifically designed to address social
isolation among LGBT elders, such as LGBT-specific and LGBT-affirming
friendly visitor programs.
•
Develop a national strategy for promoting new and meaningful volunteer
activities and civic engagement opportunities for current and future older
adults, ensuring that such opportunities are open to all, regardless of sexual
orientation and gender identity.
113
114
KEY RECOMMENDATIONS
FOR LGBT ORGANIZERS AND ADVOCATES,
WE OFFER THESE FRAMEWORKS AND APPROACHES:
Build Holistic, Strategic Approaches to Advocacy: What approaches promise
to address the needs of the broadest population of LGBT elders?
•
Securing universal health care access and culturally competent care would
meet the needs of elders across all income categories and family structures.
•
Developing LGBT-friendly public and affordable housing will meet the needs
of greater numbers of LGBT elders.
•
Prioritizing advocacy for a broader definition of family in federal programs
would address the needs of LGBT elders living in any/many different kinds of
family configurations, including single elders.
•
LGBT advocates would do well to think about peer movement coalitions that
are natural allies in the struggle for LGBT elder care, such as the disability
rights movement, racial and economic justice organizations, and HIV
advocates.
•
Given the limited capacity of the LGBT movement, what are the best strategies
for leveraging our passion and our strengths toward the greatest good?
Fight Ageism; Advance LGBT Leadership Within and Beyond the LGBT
Movement: LGBT elders have paved the way in our movement for generations.
Leaders like those profiled here best understand the needs of LGBT elders
and the strategies essential to moving us forward. LGBT elder leadership will
be critical to turning the tides of ageism, sexphobia, and homophobia in LGBT
aging services and care.
Community-Based Research is Critical: In the absence of state and federal
data, rigorous community-based research is critical. Grassroots organizations
can undertake needs assessments and other surveys on their own or partner
with community-minded researchers. The Task Force Policy Institute trains
community-based organizations and leaders in survey research annually at The
National Conference for LGBT Equality: Creating Change through our Academy
for Leadership and Action.
OUTING AGE 2010
Create Meaningful Partnerships with Aging Agencies: Local Area Agencies
on Aging, the federal Administration on Aging, non-profit entities like the
American Society on Aging (ASA) and AARP, the list goes on. LGBT people must
be visible to and engaged with mainstream aging agencies at all levels of society
and government. We must be of these groups and work with them, as insiders
and outsiders.
KEY ORGANIZING OPPORTUNITIES ON THE HORIZON:
THE 2011 REAUTHORIZATION OF THE OLDER AMERICANS ACT (OAA)
In its current form, the Older Americans Act remains massively under funded to
meet the needs of all older Americans. Organizing for the 2011 reauthorization
should focus intently on the importance of resource allocation to meet the needs
of the nation’s burgeoning aging population.
LGBT elders are also virtually invisible in the Act, which discusses the
importance of addressing the needs of “vulnerable senior constituencies” but
fails to name them. This has left LGBT advocates with an opening to advocate
for explicit language on LGBT people in the regulations for the current Older
Americans Act, something that is just underway as we go to print with this
book, and the Administration on Aging has committed to funding a National
LGBT resource center. Accordingly, a key point of organizing for the 2011
reauthorization is explicit language that identifies and defines “vulnerable senior
constituencies.” Finally, defining and mandating culturally competent care for
LGBT elders (and other vulnerable populations) could be addressed in this
bill, with LGBT advocates forming strategic coalitions with other underserved
communities.
THE 2015 WHITE HOUSE CONFERENCE ON AGING (WHCOA)
Every ten years, aging policy gets a major examination and revision through the
White House Conference on Aging. In 1995 and 2005, LGBT activists pushed
for inclusion in the aging agenda from a marginalized, outsider’s position
— movement pioneers Del Martin, Phyllis Lyon and Amber Hollibaugh were
among the advocates pivotal to these efforts. In 2015, the LGBT communities,
including experts in LGBT aging, must be on the inside of the planning process
for the WHCOA, and in the leadership that drives the conversation and policy
recommendations that flow from the gathering. “Inclusion” of LGBT issues
on a laundry list of concerns will not be enough. Leadership by recognizable,
accountable LGBT elder advocates and researchers is essential.
115
116
KEY RECOMMENDATIONS
The Task Force
is committed
to carrying this
agenda forward.
The Task Force is committed to carrying this agenda forward
and to partnering with federal and state administrations and
agencies and with LGBT and non-LGBT services providers to
ensure a healthy, dignified life for LGBT older adults. We owe
this commitment not only to the current generations of elders
to whom we are deeply indebted for our thriving communities,
our diverse and growing family structures, and our lives, but
also to LGBT Americans of all ages who dream of growing
old in a nation that will support their well-being, honor their
self-determination and respect their many contributions to our
communities and to society as a whole.
OUTING AGE 2010
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APPENDIX A
APPENDIX A
How Big is the LGBT Community?
Why Can’t I Find This Number?
270
On January 27, 2009 at its 21st annual Creating Change Conference, the
National Gay and Lesbian Task Force’s Policy Institute convened a group of 34
leading LGBT researchers, advocates and community leaders to discuss these
important questions, and to attempt to come to a consensus about how to offer
a simple response to this complex inquiry.
How big is the LGBT community? Who wants to know? Why do we care
about this?
Our discussion of the How Big question is detailed below, but equally important
is the who wants to know and why point.
Many of us spend time trying to change public policy or laws to benefit LGBT
people and their families. The size of our community is the economic cost/
benefit multiplier that policy makers use when considering our issues. How
much does employment and housing discrimination against LGBT people cost?
How much do domestic partner benefits save society in the long run? We make
our calculations, and our civil rights arguments, based (in part) on our collective
answer to the How Big question.
Over the course of our convening, from very distinct disciplines and vantage
points, participants reported several different ways that we answer this question
to the many researchers, policy makers, and members of the media who
ask us.271
270 If you are on deadline, as are many of the researchers and members of the media who ask
these questions, feel free to skip to the final paragraphs for your answer. However, if you hope
to give this important query its proper treatment, we strongly suggest reading this short paper
in its entirety.
271 Answers included: (1) It’s complicated. (2) 3-4% (Gates, Sherrill, NEPs) (3) 7-10% (YRBS
surveys, multistate) (4) One in ten. (Kinsey) (5) The size of North Carolina; or 8.8 million people,
which references the 3-4% figure in (2). (6) .25-1% of the community is transgender (a guess,
which some of us are using). (7) We don’t know.
OUTING AGE 2010
A determining factor in each response hinged on what researchers measured
and how they measured it. Researchers measuring same-sex attraction over
the lifespan came up with a much larger number than those measuring LGBT
identity in the current moment; still other numbers emerge when researchers
respond on the basis of sexual behavior over a certain time period, rather than
identity or attraction.272 On the how front, researchers asking voters as they
leave polling places in their neighborhoods whether they identify as LGB come
up with different numbers than those who ask participants to take a confidential
health survey using headphones and a computer. Privacy and confidentiality
appear to be paramount concerns for LGBT people as they consider whether to
“come out” on government, media or scholarly surveys.
HOW WE ANSWERED IN THE 60S-EARLY 90S
From the 1960s to the early 90s, political activists and popular media answered
the How Big question definitively as “one-in-ten”, or ten percent of the overall
population, drawing upon Dr. Alfred Kinsey’s ground-breaking work in sexuality
during the 1940’s and 1950’s. However, it is notable that Kinsey never claimed
this number, rather it became popularized by other academics and community
advocates drawing upon his work. Kinsey understood that his sample was
not random, so that his figures could not be generalized to the full population.
For example, he drew many of his participants from prisons, where situational
same-sex behavior is more common than outside of prison. As LGBT advocates
became more discerning about using research to describe the community, the
oft-cited one-in-ten figure came to be regarded as an overestimation of the LGB
population at large.273
HOW WE’VE ANSWERED IN THE LATE 90S TO THE PRESENT
In 1990, the U.S. Census Bureau created an unintentional sample of LGB samesex couples when it attempted to measure cohabitation among unmarried
heterosexuals in the general population. When unmarried couples who were
lesbian, gay or bisexual checked off their gender in household surveys, same-
272 Mosher, W. D., Chandra, A., & Jones, J. (2005). Sexual Behavior and Selected Health
Measures: Men and Women 15—44 Years of Age, United States, 2002. Advance data. Vital and
Health Statistics (362)
273 Sexual orientation and gender expression are two distinct, essential aspects of identity.
While lesbian, gay, bisexual and transgender people have historically constructed the “gay”
communities together, researchers seeking to quantify the community whom ask sexual
orientation questions alone fail to ascertain what percentage of the LGB community identifies
as transgender and fail to reach transgender people who identify as heterosexual altogether.
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APPENDIX A
sex partnerships became visible in a random sample for the first time in U.S.
history.274 Demographers and economists have used these figures to paint a
portrait of same-sex couples in the U.S. and to make estimates about the LGBT
population at large.
Additionally, during this period, thanks to the advocacy of AIDS and Lesbian
health activists, a few major state and federal health surveys piloted questions
about same-sex sexual behavior. From these data sources, people engaging in
same-sex behavior came to be estimated at 4-6%.275
The 90s also saw increasing interest in the voting behavior of LGB people, as
critical political races turned on both LGBT issues and tiny margins of support.
National Exit Polls (NEPs) commissioned by major television networks began
to include the LGB question so that LGB voter influence in various campaigns
might be determined. The National Exit Poll data, collected over the past 10
years, has consistently identified LGB voters as making up between 3% and 4%
of the general voting population.276
Finally, youth advocates in several states have succeeded in getting samesex behavior questions added to their annual Youth Risk Behavior Surveys
in an effort to track STI transmission and other health risks among youth. In
Massachusetts, California and New York, where same sex questions are posed,
between 4% and 10% of youth report acting on a same-sex attraction.277
274 Since the Census had no actual interest in measuring the LGB population in this manner, they
certainly also made no attempt to collect data on the transgender population, which identifies
as heterosexual as well as LGB.
275 Some of these surveys include statewide Youth Risk Behavior Surveys and state health surveys
examining risk for STIs such as HIV.
276 NEPs and Voter News Service polls have undertaken this research over the past two decades.
Ken Sherrill (Hunter) and Murray Edelman (Rutgers) are pioneer researchers in this arena.
Sherrill, Edelman and Pat Egan (NYU) collaborated on a study of LGB political behavior through
a random sampling process of Knowledge Networks, whose sampling population of fifty
thousand has identified as L, G or B at a rate of 4%. See the Hunter College Study for their
methodology. Sherrill, K., Edelman, M., & Egan, P. (2009). Findings from the Hunter College
Poll: New Discoveries about the Political Attitudes of Lesbians, Gays and Bisexuals. Retrieved
October 14, 2009, from www.law.ucla.edu/Williamsinstitute/pdf/EganEdelman%20Sherrill_
Sept%202009.pdf
277 For example, in NYC in 2007, 4.3% of male students responding to the YRBS had sex only
with males and 2.6% with both males and females, while 4.2% of female students had sex
with females only and 10.2% with both. See New York City Department of Health and Mental
Hygiene. (2007). Epiquery: NYC Interactive Health Data System. YRBS2007. Retrieved June 18,
2009, from www.nyc.gov/health/epiquery
OUTING AGE 2010
While these samples have yielded important data for researchers and advocates
to consider, they are limited:
•
NEPs compile data about LGB people who vote, which excludes LGB people
who are undocumented, not registered to vote, or otherwise alienated from
the political process. This figure then, is not a true ‘random’ sample.
•
The Census provides demographic information about LGB couples
who feel secure enough to make their relationships visible on a legal
document mandated by the federal government. Population estimates are
extrapolated from this data set, as there are no LGBT identity questions on
the Census form.
•
Health and social surveys describe the health issues and conditions of LGB
people who are reachable by phone or paper surveys in their homes, and
are willing to disclose intimate details of their sexual behavior to a stranger
or on a form.
•
Youth Risk Behavior Survey data tracks same sex behavior of the past
year, and thus offers only a snapshot of same-sex sexual behavior, rather
than LGBT identity. Additionally, literature notes that teen sexual identity is
somewhat elastic and that teens tend to misreport behaviors that might gain
negative parental or state attention or they feel to be socially undesirable.278
It is important to note that none of the samples listed above identify or quantify
transgender people at all. Recently, a 2003 New York State Adult Tobacco
Survey found that 2% of the population randomly surveyed identified as
transgender. While this figure offers a starting point for posing questions about
transgender identity and experience, there is almost no credible data that attests
to the size of this populace within the LGBT community. Accordingly, figures that
are routinely cited about the size of the LGBT communities fail to account for the
transgender population as a matter of course.
ATTRACTION, BEHAVIOR AND IDENTITY
In his article, Who is Gay? Rich Savin-Williams discusses the three major
markers of sexual orientation — attraction, behavior and identity. He concludes
that — depending on which reference point one draws upon to quantify the
community — the answer to the Who is question varies greatly.
278 There are a lot of resources on queer youth identity on the National Youth Advocacy Coalition
website, www.nyacyouth.org, and youth, sexuality and identity issues at Advocates for Youth,
www.advocatesforyouth.org.
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APPENDIX A
In the myriad settings where attraction has been measured over the past 50
years, the percentage of people who report having same-sex attraction ranges
between 4-25% of the general population.279 When queried about behavior,
research subjects report at least one same-sex encounter at rates of up to 10%.
In samples where subjects are asked whether they identify as LGB and are given
the option to check off a straight/ heterosexual, L, G or B box, the percentage
drops to approximately three to four%.
COLLECTION METHODOLOGY
Research has shown that the method by which one collects data has an effect
on a subject’s willingness to report same-sex attraction or behavior, or to identify
as L, G, B, or T. The same group of subjects reveals a higher level of same-sex
sexual behaviors and LGBT identity when asked by a mechanical voice phone
survey than when asked by a live phone interviewer.280 Face-to-face surveys
yield a lower percentage of LGB behavior and identity than more anonymous
collection methods.281 While LGBT stigma has certainly declined over the past
40 years of visible and vigorous LGBT activism, there is no doubt that antiLGBT bias remains a fact of life, and that any survey of our population, including
community-based samples, provides an undercount that is fueled by fear.
RACE, CLASS, AND RELATIONSHIP TO THE STATE
Historically, communities that have been targeted by the state for discrimination
and violence are less likely to identify themselves on government surveys. This
phenomenon partly explains the huge jump in same-sex couples we observed
in the Census between 1990 and 2000. In 1990 LGB fear and skepticism about
the Census appears to have caused significant under-reporting of same-sex
relationships with 145,130 couples reporting. The Task Force and other groups
conducted a community-wide education campaign about the importance of
Census data, and researchers have used this data over the past two decades
to make economic arguments in favor of LGBT civil rights. The jump from 1990
279 See Savin-Williams, Dickson, N., Paul, C., & Herbison, P. (2003). Same-sex Attraction in a Birth
Cohort: Prevalence and Persistence in Early Adulthood. Social Science & Medicine, 56(8),
pp.1607-1615.
280 Tourangeau, R., & Smith, T. (1996). Asking Sensitive Questions: The Impact of Data Collection
Mode, Question Format, and Question Context. Public Opinion Quarterly 60, pp.275-304
281 Villarroel, M. A., Turner, C. F., Eggleston, E., Al-Tayyib, A., Rogers, S. M., Roman, A. M., et al.
(2006). Same-gender Sex in the United States: Impact of T-Acasi on Prevalence estimates.
Telephone audio computer-assisted self-interviewing. Public Opinion Quarterly 70(2)
OUTING AGE 2010
to 2000 — of an additional 456,079 couples, totaling 601,209 identifying as
“unmarried partners” — simply cannot be explained by an increased interest in
partnership among LGB people in that period.282 Rather, the critical importance
of making our community visible, and the efficacy of demographic data in civil
rights struggles has persuaded more members of the community to overcome
their fear of stigma or censure and report their relationship status on the Census.
When we apply this analysis to people of color communities that have been
disproportionately targeted for incarceration and policing, to immigrants and
undocumented people, and to people stigmatized by poverty — we can imagine
that the double or triple jeopardy these LGBT people experience may prove an
overwhelming barrier to responding frankly to such an inquiry.
VANTAGE POINTS
At the Creating Change convening, each of us answered the How Big question
from our unique vantage points. Those of us with academic training in the
health or political sciences offered views grounded by the rigors of our specific
disciplines. Advocates representing various constituencies offered friendly
critiques of current research frameworks: Youth workers noted that without
expanding our LGBT boxes to include a response choice for Queer, we would
likely be undercounting the LGBT youth population. A leader in the African
American community reported that none of the Black men in his life identified
as LGBT, but as homosexual, and would be unlikely to respond to questions
as they are currently constructed on either federal and community-based
surveys. Transgender advocates noted that the language and identifiers of
the transgender communities vary greatly across income, education, race and
geography.
HOW BIG IS THE LGBT COMMUNITY?
Sifting through the tremendous expertise and disparate viewpoints shared in
our national convening, and with the huge caveat that this is a complicated
question, the Task Force Policy Institute offers the following:
Given the realities of anti-LGBT bias and violence, and taking into account that
there is no comprehensive employment legislation protecting LGBT workers,
282 Gaydemographics.org. 1990 Census Results for Same-sex Couples. Retrieved June 29, 2009,
from www.gaydemographics.org/USA/1990_Census.htm ; Gaydemographics.org. 2000 Census
results for Same-sex Couples. Retrieved June 29, 2009, from www.gaydemographics.org/
USA/2000Census_Gay_state.htm
137
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APPENDIX A
an unknown percentage of the community will decline to identify as LGBT on
federal, state and community-based questionnaires.
Random sampling such as the National Survey of Family Growth, and not-quite
random samples such as the NEP surveys provide a “floor” estimate of the
community at about 4% of the general population.
When we look to current state and federal health survey data, which collects
information on same-sex sexual behaviors, including Youth Risk Behavior
Surveys, we come to a figure between 4-10%.
However, given the fact that there is currently little to no research that samples
transgender people in the general population, and the reality that highly
vulnerable LGBT people — including a percentage of gender-nonconforming/
trans people, people of color, immigrants, non-English speakers, undocumented
and low-income people — are unlikely to identify as LGBT on even an
anonymous questionnaire, we believe that the lower end of the 4-10% figure
significantly undercounts the community.
Accordingly, the Task Force Policy Institute estimates the LGBT population —
that is people who identify as LGBT or create family or sexual affiliations that
involve people of the same sex — as somewhere between 5-10% of the general
population.
OUTING AGE 2010
APPENDIX B
LGBT Cultural Competency Curricula
The vast majority of LGBT people who need to access elder housing, assisted
living and nursing care facilities will do so through mainstream providers.
Accordingly, trainings in cultural competency for these providers are essential to
the well-being of the LGBT community.
Cultural competency programs are not uniformly effective. Many superficial
“diversity” programs fail to address the nexus of power and prejudice that
creates hostile, unsafe care environments. Many such programs fail to explore
or illuminate the specific needs and vulnerabilities of LGBT elders, throwing
LGBT people onto a laundry list of diverse populations that have greatly varied
social, cultural, familial and care needs. The list below describes LGBT cultural
competency curricula that have been developed within LGBT-specific aging
programs by LGBT elders and advocates. They are the cream of the crop, and
offer excellent training for staff at all levels of care provision.
Many of our policy recommendations in Outing Age 2010 promote cultural
competency training mandates in housing, assisted living and nursing care
facilities. Without such trainings, LGBT elders remain at great risk for neglect
and abuse.
BROOKDALE CENTER ON AGING OF HUNTER COLLEGE AND SAGE, NY
NO NEED TO FEAR, NO NEED TO HIDE: A Training Program about Inclusion
and Understanding of Lesbian, Gay, Bisexual and Transgender Elders For LongTerm Care and Assisted Living Facilities. Go to www.sageusa.org for more
information
PROJECT VISIBILITY, BOULDER, CO
Project Visibility is an award-winning documentary produced for Boulder County
Aging Services and is used as part of a training program to raise awareness of
the issues facing elder gays and lesbians. Go to projectvisibility.org
The LGBT Aging Project, MA offers trainings in cultural competency.
Go to: www.lgbtagingproject.org
139
140
APPENDIX B
openhouse: housing, services and community for LGBT people in San
Francisco offers training in cultural competency. www.openhouse-sf.org/
resources/training
See also:
SAGEConnect is a collaborative on-line community for organizations and
individual advocates who work on LGBT aging issues, providing a space where
participating members can exchange information and engage in ongoing
communication about their shared interest in creating a better quality of life
for LGBT older people. SAGEConnect includes samples of several cultural
curriculum training programs, templates for more inclusive intake forms, and
similar resources.
OUTING AGE 2010
APPENDIX C
The Road Map to Federal Funding
for Aging Services
Navigating the Federal Government
for LGBT Organizations
PRIORITY AREAS
•
Nutrition Services
•
Housing
•
Community and Supportive Services
•
Older Workers Programs
•
Senior Employment and Opportunity Programs
•
Elder Rights and Protections
•
Grants for Native Americans
NOTE ON THE ELDERCARE LOCATOR
The Administration on Aging established the Eldercare Locator as a nationwide
service to help families and friends find information about community services
for older people. The Eldercare Locator provides access to an extensive network
of organizations serving older people at state and local community levels. To
locate a State or Local Area Agency on Aging, call the Eldercare Locator toll
free at 1-800-677-1116 or go to www.eldercare.gov.
141
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APPENDIX C
NUTRITION SERVICES
CONGREGATE NUTRITION SERVICES
(OLDER AMERICANS ACT, TITLE III)
The OAA’s Congregate Nutrition Services aim to reduce hunger and food
insecurity, promote socialization of older individuals, and assist older individuals
in gaining access to nutrition and disease prevention services. Specific services
include providing nutritious meals in a group setting, delivering nutrition
education, and providing other appropriate services to help older American’s
maintain their health, independence and quality of life.
Statutory Authority
• Older Americans Act of 1965, Title III, Section 331
Federal Funding:
• FY2008 appropriated - $410,716,000
• FY2009 appropriated - $434,269,000
Participant and Program Requirements:
• Participants include:
– Persons who are age 60 or older, especially those older
individuals with the greatest social or economic need, and their
spouse of any age
– Persons under age 60 with disabilities who reside in housing
facilities occupied primarily by the elderly where congregate meals
are served
– Persons with disabilities who reside at home with, and accompany,
older individuals
– Volunteers who provide services during the meal hours.
• Nutrition Service Providers are required to:
– Provide at least one meal per day, five days a week or more
(except in rural areas if five days a week is not feasible and a lesser
frequency has been approved by the state agency on aging)
– Provide at least one “hot or other appropriate meal per day”;
– Provide services in congregate settings, including adult care
facilities and multigenerational meal sites; and
OUTING AGE 2010
– Provide nutrition education, nutrition counseling, and other nutrition
services, as appropriate, based on the needs of meal participants.
Funding and Eligibility Information:
• All States and US Territories which have State Agencies on Aging
designated by the governors are eligible for funding.
• Funds are awarded to State Agencies through a statutory formula.
How to Apply:
• Contact your Area Agency on Aging (AAA) or State Agency on Aging for
more information.
• Information on these agencies is available through the Eldercare
Locator at www.eldercare.gov.
Web site: www.aoa.gov
HOME DELIVERED NUTRITION SERVICES
(OLDER AMERICANS ACT, TITLE III)
Home Delivered Nutrition Services, informally referred to as “Meals on Wheels,”
aims to reduce food insecurity and assist older individuals in gaining access to
nutrition and disease prevention services. Service providers deliver nutritious
meals to the homes of older Americans at least once a day, five days a week.
Federal Oversight:
• Administration on Aging, Department of Health and Human Services
Statutory Authority:
• Older Americans Act of 1965, Title III, Section 336
Federal Funding:
• FY2008 appropriated - $193,858,000
• FY2009 appropriated - $214,459,000
Participant and Program Requirements:
• Participants include:
– Persons who are age 60 or older, especially those older individuals with
the greatest social or economic need, and their spouse of any age
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144
APPENDIX C
– Persons under age 60 with disabilities who reside in housing
facilities occupied primarily by the elderly where congregate meals
are served
– Persons with disabilities who reside at home with, and accompany,
older individuals
– Volunteers who provide services during the meal hours.
– An older individual must be assessed to be homebound
– A spouse of a homebound individual regardless of age or condition
may receive a meal if receipt of the meal is assessed to be in the
best interest of the homebound older adult.
• Nutrition service providers are required to:
– Provide at least “one hot, cold, frozen, dried, canned, fresh or
supplemental foods” meal per day; and
– Provide nutrition education, nutrition counseling, and other nutrition
services as appropriate based on needs of meal recipients.
Funding and Eligibility Information:
• All States and US Territories which have State Agencies on Aging
designated by the governors are eligible for funding.
• Funds are awarded to State Agencies through a statutory formula.
• The law requires State Agencies to provide a 15% match to the amount
appropriated by the federal government.
How to Apply:
• Contact your Area Agency on Aging (AAA) or State Agency on Aging
(SAA) for more information.
• Information on these agencies is available through the Eldercare
Locator at www.eldercare.gov.
Web site: www.aoa.gov
OUTING AGE 2010
NUTRITION SERVICES INCENTIVE PROGRAM (NSIP)
The OAA’s Nutrition Services Incentive Program awards funds to State Agencies
on Aging (SSAs), Area Agencies on Aging (AAAs), and Indian Tribal Organizations
to purchase foods of United States origin or to purchase commodities from the
United States Department of Agriculture (USDA). These foods are to be used in
the preparation of congregate and home-delivered meals by nutrition services
programs. Community organizations may be eligible to receive funds through
their designated SSA or AAA.
Federal Oversight:
• Administration on Aging, Department of Health and Human Services
Federal Funding:
• FY2008 appropriated - $153,429,000
• FY2009 appropriated - $161,015,000
Statutory Authority:
• Older Americans Act of 1965, Title III, section 311
• Agricultural Act of 1949, section 416
• Provides that a grant recipient shall receive food commodities from the
Commodities Credit Corporation
• Food and Agricultural Act of 1965, Section 709
• Dairy products shall be used to meet the requirements of nutrition
services in accordance with OAA.
Participant and Program Requirements:
• Participants include:
– Persons who are age 60 or older, especially those older individuals with
the greatest social or economic need, and their spouse of any age
– Persons under age 60 with disabilities who reside in housing
facilities occupied primarily by the elderly where congregate meals
are served
– Persons with disabilities who reside at home with, and accompany,
older individuals
– Volunteers who provide services during the meal hours.
– An older individual must be assessed to be homebound
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APPENDIX C
– A spouse of a homebound individual regardless of age or condition
may receive a meal if receipt of the meal is assessed to be in the
best interest of the homebound older adult.
Funding and Eligibility Information:
• Funds are awarded to SSAs, AAAs, and Indian Tribal Organizations
through a statutory formula.
• If community organizations enter into a contract or grant agreement
with their SSA or AAA to provide meals in compliance with Title III of the
OAA, the community organization may receive NSIP funding from that
entity.
• Some community organizations are not eligible to participate in NSIP.
For example, privately funded Meals on Wheels programs that are not
associated with a SSA or AAA or assisted living facilities that do not
provide meals to the general public and are not associated with a SSA
or AAA are not eligible to participate in NSIP.
How to Apply:
• Funds for Nutrition Services Incentive Grants are allotted to states
based on a statutory formula that takes in account the number of meals
served by each state’s nutrition program the prior year.
• Contact your SAA or AAA for more information.
• Information on these agencies is available through the Eldercare
Locator at www.eldercare.gov.
Web site: www.aoa.gov
OUTING AGE 2010
COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP)
The Commodity Supplemental Food Program provides food and administrative
funds to SAAs, AAAs, and Indian Tribal Organizations to supplement the diets of
older adults, pregnant and breastfeeding women, and children up to six years
of age. These agencies distribute funds to participating local public or private
nonprofit agencies. The CSFP food packages do not provide a complete diet,
but rather are good sources of the nutrients typically lacking in the diets of the
target population.
Federal Oversight:
• Food and Nutrition Service (FNS) - United States Department of
Agriculture (USDA)
Federal Funding:
• FY2009 appropriated — $160,430,000
Statutory Authority:
• Agriculture and Consumer Protection of 1973, Section 4(a)
• Agricultural Act of 1949
• Child Nutrition Act of 1966
• Commodity Credit Corporation Charter of 1933
• Section 32 of the Agricultural Act of 193
• Part 247 - CSFP Regulations of Food and Nutrition Services of USDA
• Part 250 — Food Distribution Programs FDP Donation of Food
Regulations
Participant and Program Requirements:
• Participants must reside in a State participating in CSFP.
• Elderly persons must be at least 60 years of age who meet income
eligibility requirements.
Funding and Eligibility Information:
• States establish an income limit for eligible participants at or below
130% of the federal poverty line.
• State agencies store the food and distribute it to public and non-profit
private local agencies.
147
148
APPENDIX C
• Local agencies determine the eligibility of applicants, distribute the food
to participants, and provide nutrition information.
How to Apply:
• Contact your State Distributing Agency (SDA) for further assistance.
For a list of SDA contacts, go to www.fns.usda.gov/fdd/contacts/sda
contacts.htm
Web site: www.fns.usda.gov/fdd/programs/csfp/
OUTING AGE 2010
HOUSING
SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY (HUD)
Section 202 Supportive Housing for the Elderly aims to provide interest-free
capital advance grants to private, nonprofit sponsors to finance the development
of housing for the elderly.
Federal Oversight:
• Department of Housing and Urban Development (HUD)
Statutory Authority:
• The Housing Act of 1959
• Section 210 of the Housing and Community Development Act of 1974
• Cranston-Gonzalez National Affordable Housing Act
• Housing and Community Development Act of 1992
• The Rescissions Act
• American Homeownership and Economic Opportunity Act of 2000
• Program regulations are in 24 Code of Federal Regulations Part 891
Participant and Program Requirements:
• Section 202 housing is open to any very low-income household
comprised of at least one person who is at least 62 years old at the
time of initial occupancy.
• Capital advances do not have to be repaid as long as the project serves
very low-income elderly persons for 40 years.
Funding and Eligibility Information:
• Applicant must have private, nonprofit status (Public entities are NOT
eligible).
• Applicant must have a financial commitment and acceptable control of
an approvable site.
• For more requirements, see www.hud.gov/offices/hsg/mfh/progdesc/
eld202.cfm.
149
150
APPENDIX C
How to Apply:
• An applicant should consult the office or official designated as the
single point of contact in his or her state for more information on the
process the state requires to be followed in applying for assistance.
• A Notice of Fund Availability is published in the Federal Register each
fiscal year announcing the availability of funds to HUD Field Offices.
• Applicants must submit a Request for a Fund Reservation, using
Form HUD-92015-CA, Section 202 application for capital advance, in
response to the Notice of Fund Availability (or a Funding Notification
issued by the local HUD Field Office).
• The application for a capital advance is used to determine the eligibility
of the applicant and proposed project as well as the acceptability of the
site and market, correctness of zoning, and the effect on environment.
Web site: www.hud.gov
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS
(HOPWA) PROGRAM
HOPWA provides grants to local communities, states, and nonprofit
organizations to devise long-term comprehensive strategies for meeting the
housing needs of low income persons medically diagnosed with HIV/AIDS and
their families. Funds may be used for a wide range of housing, social services,
program planning, and development costs. In addition, funds may be used
for health care and mental health services, chemical dependency treatment,
nutritional services, case management, assistance with daily living, and other
supportive services.
Federal Oversight:
• Department of Housing and Urban Development (HUD)
Federal Funding:
• FY2009 appropriated $276,088,000
Statutory Authority:
• AIDS Housing Opportunity Act
OUTING AGE 2010
Participant and Program Requirements:
• Participants are low income persons with HIV or AIDS and their families.
• Pursuant to Section 574.3, Title 24 (Housing and Urban Development)
of the Code of Federal Regulations, “family” means a household
composed of two or more related persons. The term family also
includes one or more eligible persons living with another person or
persons who are determined to be important to their care or well being,
and the surviving member or members of any family described in this
definition who were living in a unit assisted under the HOPWA program
with the person with AIDS at the time of his or her death.
• Specific uses and restrictions are available at www.hud.gov/offices/
cpd/aidshousing/programs/.
Funding and Eligibility Information:
• HOPWA funds are awarded as grants from one of three programs:
• HOPWA Formula Program (90% of funding) - uses a statutory method
to allocate HOPWA funds to eligible States and cities on behalf of their
metropolitan areas.
• HOPWA Competitive Program - a national competition to select model
projects or programs.
• HOPWA National Technical Assistance - funding awards are provided
to strengthen the management, operation, and capacity of HOPWA
grantees, project sponsors, and potential applicants of HOPWA
funding.
How to Apply:
• Contact your Regional or Local HUD Office
• Visit www.hud.gov/offices/cpd/aidshousing/programs/
for more info
Web site: www.hud.gov
151
152
APPENDIX C
The following are just a few examples of groups and programs
throughout the country which have successfully secured government
funding for LGBT elder services
•
Gay and Lesbian Elder Housing (GLEH) developed an affordable LGBTcentric housing project in Hollywood, Triangle Square, partially through HUD
funding.
•
SAGE Milwaukee has accessed funds through their local Area Agency on
Aging, the Milwaukee County Office for Aged.
•
Sunserve, a senior services program in Ft. Lauderdale, successfully obtained
funds for its LGBT program through their local Area Agency on Aging.
•
The Transgender Aging Project and FORGE have obtained Department of
Justice money for hate crimes training on transgender issues.
•
The LGBT Aging Project of Massachusetts has developed a federally funded
congregate meal program for LGBT older adults.
OUTING AGE 2010
APPENDIX D
LGBT AGING ADVOCACY AND PROVIDER PROGRAMS
National
Azteca Project
aztecaproject.org
P.O. Box 7678
Chula Vista, CA 91912
National Center for Lesbian Rights
www.nclrights.org
870 Market Street, Ste. 570
San Francisco, CA 94102
National Gay & Lesbian Task Force
www.thetaskforce.org
1325 Massachusetts Ave. NW
Suite 600
Washington, DC 20005
Phone: 202.393.5177
Fax: 202.393.2241
National Sexuality Resource Center
www.nsrc.sfsu.edu
835 Market Street, Ste. 517
San Francisco, CA 94103
Lambda Legal
www.lambdalegal.org
120 Wall Street, Ste. 1500
New York, NY 10005
National Coalition for LGBT Health
www.lgbthealth.net
1325 Massachusetts Ave. NW
Washington, DC 20005
Services & Advocacy for GLBT Elders
(SAGE)
www.sageusa.org
305 Seventh Avenue, Sixth Floor
New York, NY 10001
Phone: 212.741.2247
Old Lesbians Organizing Change (OLOC)
www.oloc.org
P.O. Box 5853
Athens, OH 45701
National Association on HIV Over 50
www.hivoverfifty.org
23 Miner Street
Ground Level
Boston, MA 02215-3319
JCampbell@HIVoverFifty.org
American Society on Aging,
LGBT Aging Issues Network
www.asaging.org/LAIN/
833 Market Street
San Francisco, CA 94104
Primetimers
www.primetimersww.org
Transgender Aging Network
www.forge-forward.org/tan/
6990 N. Rockledge Avenue
Glendale, WI 53209
153
154
APPENDIX D
Northeast
New York City
American Veterans for Equal Rights
www.aver.us
P.O. Box 150160
Kew Gardens, NY 11415
Gay Men’s Health Crisis (GMHC)
www.gmhc.org
119 West 24th Street
New York, NY 10011
CenterSAGE
Hudson Valley LGBTQ Center
P.O. Box 3994
Kinston, NY 12402
GRIOT Circle
www.griotcircle.org
25 Flatbush Avenue
Brooklyn, NY 11217
LGBT Aging Project
www.lgbtagingproject.org
555 Amory Street
Jamaica Plain, MA 02130
SAGE/Queens
www.queenscommunityhouse.org
Queens Community House
74-09 37th Avenue, #409
Jackson Heights, NY 11372
SAGE Long Island
www.sageli.org
34 Park Avenue
Bay Shore, NY 11706
SAGE Upstate
www.sageupstate.org
P.O. Box 6271
Syracuse, NY 13217
Stonewall Communities
www.sites.stonewallcommunities.org/
PO Box 990035
Boston, MA 02199
daronstein@stonewallcommunities.org
Rainbow SAGE of the Genesee Valley
www.rainbowseniorswny.org
121 North Fitzhugh
Rochester, NY 14614
Mid-Atlantic Region
SAGE Philadelphia at William Way
www.waygay.org
1315 Spruce St.
Philadelphia, PA 19107
SAGE Rainbow Bridge Connection
rbcnlmcc.org/home
Hampton Roads, VA
South
SAGE South Florida
www.sagewebsite.org
8333 W. McNab Road, Ste. 239
Tamarac, FL 33321
OUTING AGE 2010
Midwest
California
SAGE Center On Halsted
www.centeronhalsted.org
3656 N. Halsted
Chicago, IL 60613
Aging As Ourselves
www.agingasourselves.org
4069 30th Street
San Diego, CA 92104
Sage Metro St. Louis
www.sagemetrostl.org
P.O. Box 260016
St. Louis, MO 63126
Gay & Lesbian Elder Housing
www.gleh.org
1602 N. Ivar Avenue
Hollywood, CA 90028
SAGE Milwaukee
www.sagemilwaukee.org
1845 N. Farwell Avenue, Ste. 220
Milwaukee, WI 53202
Lavender Seniors of the East Bay
www.lavenderseniors.org
1395 Bancroft Ave.
San Leandro, CA 94577
Howard Brown Health Clinic
www.howardbrown.org/
4025 N. Sheridan Road
Chicago, IL 60613
L.A. Gay & Lesbian Community Center
www.lagaycenter.org
1125 N. McCadden Place
Los Angeles, CA 90038
West
New Leaf Services
www.newleafservices.org
1390 Market Street, Ste. 800
San Francisco, CA 94102
Gay and Gray In The West
www.gayandgrayinthewest.org
6790 W. 45th Place
Wheat Ridge, CO 80033
SAGE of the Rockies
www.glbtcolorado.org
P.O. Box 9798
Denver, CO 80209-0798
SAGE Utah
www.utahpride.org
361 N 300 W
Salt Lake City, UT 84103
(801) 539-8800
Open House
www.openhouse.com
870 Market Street, Ste. 458
San Francisco, CA 94102
155
156
APPENDIX E
State has NonDiscrimination Law,
Sexual Orientation
State has NonDiscrimination Law,
Gender Identity
State Office or
Division on Aging
has Age NonDiscrimination Policy
State Office or
Division on Aging
has Sexual
Orientation NonDiscrimination Policy
State Office or
Division on Aging has
Gender Identity NonDiscrimination Policy
Alabama
YES
NO
NO
NO
NO
NO
Alaska
YES
NO
NO
NO
YES
NO
Arizona
YES
NO
NO
NO
NO
NO
Arkansas
YES
NO
NO
NO
YES
NO
California
YES
YES
YES
NO
NO
NO
Colorado
YES
YES
YES
YES
YES
NO
Connecticut
YES
YES
NO
NO
NO
NO
Delaware
YES
NO
NO
NO
NO
NO
District of
Columbia
YES
YES
YES
NO
NO
NO
Florida
YES
NO
NO
NO
NO
NO
Georgia
YES
NO
NO
NO
NO
NO
Hawaii
YES
YES
YES
NO
NO
NO
Idaho
YES
NO
NO
NO
NO
NO
Illinois
YES
YES
YES
YES
YES
YES
Indiana
YES
NO
NO
NO
NO
NO
Iowa
YES
YES
YES
NO
NO
NO
Kansas
NO
NO
NO
NO
NO
NO
Kentucky
YES
NO
NO
NO
NO
NO
Louisiana
YES
NO
NO
NO
NO
NO
Maine
YES
YES
YES
NO
NO
NO
Maryland
YES
YES
NO
NO
NO
NO
Massachusetts
YES
YES
NO
NO
NO
NO
Michigan
YES
NO
NO
NO
NO
NO
Minnesota
YES
YES
YES
NO
NO
NO
Mississippi
NO
NO
NO
NO
NO
NO
Missouri
YES
NO
NO
NO
NO
NO
Montana
YES
NO
NO
NO
NO
NO
Nebraska
NO
NO
NO
YES
NO
NO
State
State has NonDiscrimination
Law, Age
APPENDIX E: LGBT AGING STATE-BY-STATE
State has NonDiscrimination Law,
Gender Identity
State Office or
Division on Aging
has Age NonDiscrimination Policy
State Office or
Division on Aging
has Sexual
Orientation NonDiscrimination Policy
State Office or
Division on Aging has
Gender Identity NonDiscrimination Policy
Nevada
YES
YES
NO
YES
NO
NO
New
Hampshire
YES
YES
NO
YES
NO
NO
New Jersey
YES
YES
YES
NO
NO
NO
New Mexico
YES
YES
YES
YES
YES
YES
New York
YES
YES
NO
NO
YES
NO
North
Carolina
YES
NO
NO
YES
NO
NO
North
Dakota
YES
NO
NO
YES
YES
NO
Ohio
YES
NO
NO
YES
YES
NO
Oklahoma
YES
NO
NO
YES
NO
NO
Oregon
YES
YES
YES
NO
NO
NO
Pennsylvania
YES
NO
NO
NO
NO
NO
Rhode
Island
YES
YES
YES
NO
NO
NO
South
Carolina
YES
NO
NO
YES
NO
NO
South
Dakota
NO
NO
NO
NO
NO
NO
Tennessee
YES
NO
NO
YES
NO
NO
Texas
YES
NO
NO
NO
NO
NO
Utah
YES
NO
NO
NO
NO
NO
Vermont
YES
YES
YES
NO
NO
NO
Virginia
YES
NO
NO
NO
NO
NO
Washington
YES
YES
YES
YES
YES
YES
West Virginia
YES
NO
NO
NO
NO
NO
Wisconsin
YES
YES
NO
YES
YES
NO
Wyoming
YES
NO
NO
NO
NO
NO
State
State has NonDiscrimination Law,
Sexual Orientation
157
State has NonDiscrimination
Law, Age
OUTING AGE 2010
Note: These non-discrimination laws and policies do not establish uniform protections. Areas of protection might
include employment, public accommodations, housing, education, real estate, credit, insurance and health
maintenance organizations. Please see individual states’ law codes for details.
158
POLICY INSTITUTE BESTSELLERS
California’s Proposition 8:
WHAT HAPPENED, AND WHAT DOES
THE FUTURE HOLD?
Policy Institute Bestsellers
Preliminary Findings, National
Transgender Discrimination Survey
Based on data from the National Center for Transgender
Equality/National Gay and Lesbian Task Force study,
this fact sheet demonstrates the impact of employment
discrimination on transgender people by tracking
unemployment, harassment at work, and poverty.
www.thetaskforce.org/reports_and_research
Opening the Door
to the Inclusion of
Transgender People:
THE NINE KEYS TO MAKING LESBIAN, GAY,
BISEXUAL AND TRANSGENDER ORGANIZATIONS
FULLY TRANSGENDER-INCLUSIVE
An in-depth analysis of the Proposition 8 vote, which
finds that party affiliation, political ideology, frequency
of attending worship services and age were the driving
forces behind the measure’s passage.
www.thetaskforce.org/reports_and_research/
time_to_build_up
Lesbian, Gay, Bisexual
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AN EPIDEMIC OF HOMELESSNESS
Of the estimated 1.6 million homeless American youth,
between 20 and 40% are lesbian, gay, bisexual or
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only on the streets, but in the shelter system as well.
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youth_exec_sum
Living in the Margins:
A NATIONAL SURVEY OF LGBT ASIAN
AND PACIFIC ISLANDER AMERICANS
This new publication, jointly produced by the Task Force
and the National Center for Transgender Equality, guides
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organizations fully transgender-inclusive.
Using data from the largest-ever national survey of
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finds that 75% of respondents report experiencing
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orientation.
www.thetaskforce.org/reports_and_research/
opening_the_door
hwww.thetaskforce.org/reports_and_research/
api_study_executive_summary
A Time to Build Up:
Building an Inclusive Church:
ANALYSIS OF THE NO ON PROP. 8 CAMPAIGN
AND ITS IMPLICATIONS FOR FUTURE PROLGBTQQIA RELIGIOUS ORGANIZING
A WELCOMING TOOLKIT
The Task Force’s report, A Time to Build Up: Analysis of
the No on Proposition 8 Campaign and Its Implications
for Future Pro-LGBTQQIA Religious Organizing, examines
the Proposition 8 battle in California, highlighting
religious-secular partnerships relevant to marriage
equality.
www.thetaskforce.org/reports_and_research/
time_to_build_up
If we’ve learned anything in the Post-Prop 8 environment,
it is the power of organizing religious denominations.
Accordingly, the Task Force’s Institute for Welcoming
Resources continues to spearhead the development of
Welcoming Congregations within mainline Protestant faith
traditions. Drawing upon twenty-five years of experience
within a variety of Christian denominations, this Toolkit is a
step-by-step guide to help facilitate a Welcoming Process
in your local congregation. Biblically and theologically
based, it uses tools of relational organizing, congregational
assessment, conflict management and change theory.
www.welcomingresources.org/welcomingtoolkit.pdf
OUTING AGE 2010
National Gay and Lesbian Task Force Board
Marsha Botzer *
Jeff Adler
TJ Michels
Co-Chair
Seattle, WA
New York, NY
Long Beach, CA
John M. Allen *
Nicole Murray-Ramirez
Lee Rubin *
Detroit, MI
San Diego, CA
Co-Chair
Chevy Chase, MD
Sydney Andrews
Andrew Ogilvie
Denver, Colorado
Los Angeles, CA
Anthony Aragon
Robert Salem
Denver, CO
Toledo, OH
Margaret A. Burd *
Andrew Solomon
Thornton, CO
New York, NY
Jerry N. Clark
Hope Wine, Psy.D.
David da Silva Cornell
Washington, DC
Miami Beach, FL
Secretary
Miami Beach, FL
Julie R. Davis
Vince Wong
San Francisco, CA
Los Angeles, CA
William Forrest
Sarah N. Fletcher
Paula Redd Zeman
Treasurer
Chicago, IL
Seattle, WA
Mamaroneck, NY
Hans Johnson
Vice Co-Chair
Los Angeles, CA
Moonhawk River Stone
Vice Co-Chair
Albany, NY
Suzanne Goldstein
Alan J. Bernstein *
Washington, DC
Member at Large
West Hollywood, CA
Mario Guerrero
Sacramento, CA
Pam David
Member at Large
San Francisco, CA
Craig Hoffman **
Michelle Stecker
Duane C. Ingram **
Member at Large
Ewing, NJ
Philadelphia, PA
R. Peter Wharton
New York, NY
Member at Large
Miami Beach, FL
Jody Laine
Washington, DC
Eric von Kuersteiner *
Seattle, WA
* serves on both c3 & c4
** serves on c4 only
Updated 9/24/09
159
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National Gay and Lesbian Task Force Staff
EXECUTIVE OFFICE
Sarah Reece
Brian Johnson
Project Director
Chief Financial Officer
Trystan Reese
Rea Carey
Field Organizer
Executive Director
Barbara Satin
Julie Childs
IWR and Faith Work Coordinator
Executive Assistant
Rebecca Voelkel
Ellen Kitzerow
Institute for Welcoming Resources Program Director
Board Liaison
Lisa Weiner-Mahfuz
Director of Capacity Building Project Director
PROGRAM DEPARTMENTS
Darlene Nipper
POLICY INSTITUTE
Deputy Executive Director
Jaime Grant
Cliffie Bailey
Director, Policy Institute
Executive Assistant
Somjen Frazer
Senior Policy Analyst
ACADEMY FOR LEADERSHIP AND ACTION
Dan Hawes
PUBLIC POLICY AND GOVERNMENT AFFAIRS
Director, Academy for Leadership and Action
Laurie Young
Rebecca Ahuja
Interim Director, Public Policy and Government Affairs
Senior Field Organizer
Lisa Mottet
Kathleen Campisano
Transgender Civil Rights Project Director
Senior Field Organizer
David Lohman
EXTERNAL RELATIONS
IWR and Faith Work Coordinator
Russell Roybal
Moof Mayeda
Deputy Executive Director of External Relations
Senior Field Organizer
Andrew Machado
Trina Olson
Senior Field Organizer
Executive Assistant
OUTING AGE 2010
COMMUNICATIONS
FINANCE & ADMINISTRATION
Inga Sarda-Sorensen
Brian Johnson
Director of Communications
Chief Financial Officer
Sarah Kennedy
Sandra Greene
Interactive Media Coordinator
Director of Administration
Pedro Julio Serrano
Michael Lloyd
Communications Manager
Accounting Manager
Jorge Taveras
Charles Matiella
Communications Associate
Senior Technology Manager
Barney Thomas
CREATING CHANGE
Finance Associate
Sue Hyde
Henry Woodside
Director of Creating Change
Database Administrator
Marta Alvarado
Program Coordinator
DEVELOPMENT
Michael Bath
Special Events Manager
Alex Breitman
Special Events Manager
David Cook
Development Coordinator
Cynde Horne
Assistant Director of Major Gifts
Jose Lugaro
Director of Major and Annual Gifts
Janice Thom
Director of Operations
Ezra Towne
Membership Manager
Dorrit Walsh
Senior Web Manager
161
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The National Gay and Lesbian
Task Force Policy Institute
is the nation’s premiere think tank working on the advancement of social, racial,
economic and gender justice for the lesbian, gay, bisexual and transgender
communities. The Policy Institute undertakes original research, analysis and
strategic projects to create greater understanding about LGBT people and
secure full equality for all.
The National Gay and Lesbian Task Force
Policy Institute
1325 Massachusetts Avenue, NW
Washington, DC 20005
202.393.5177
www.theTaskForce.org
Outing Age 2010
The National Gay and Lesbian Task Force is grateful to
the Arcus Foundation and to AARP whose generous support
funded the research and distribution of this publication.
THE NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE
1325 Massachusetts Avenue, NW
Washington, DC 20005
202.393.5177
www.theTaskForce.org